1. www.iofbonehealth.org Osteoporosis in the European Union: medical management, epidemiology and economic burden (EU-27 Report) EU Osteoporosis Consultation Panel Meeting – 27 November 2013 Prof Juliet Compston International Osteoporosis Foundation (IOF) European Federation of Pharmaceutical Industry Associations (EFPIA)

2. Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 1

3. 2 HOW MANY PEOPLE IN THE EU HAVE OSTEOPOROSIS? 2010 Figures / Over age 50 / Based on WHO diagnostic criteria (T-score less than or equal to -2.5SD)

4. NEW FRACTURES IN EU IN 2010 Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 3 Total number of incident fractures in 2010 – 3.5 million

5. HIP FRACTURE – A MAJOR BURDEN IN COSTS, DISABILITY, EARLY DEATH Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 4 Hip fracture incidence/100,000 in men and women above 50 years standardized to the EU27 population

6. MORTALITY DUE TO FRACTURE  42,000 deaths in 2010 directly attributable to fractures within the first year Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 5 Proportion of deaths due to fracture by site

7. HIGH COST BURDEN OF OSTEOPOROSIS Cost of osteoporosis is €37 billion  Direct costs of treating fractures =66%  Long-term fracture care = 29%  Prevention = 5% Despite enormous costs to care for fractures, only 5% is spent on prevention Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 6

8. HIP FRACTURES ARE MOST COSTLY  Hip fractures represent 54% of the costs Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 7 Others; 39% Forearm; 2% Spine; 5%Hip; 54%

9. BURDEN OF FRACTURES IN 2010  Estimated number of life-years lost in the EU due to fractures is 26,300  Total health burden is estimated at 1,180,000 QALYS for EU (QALY=quality-adjusted life year)  Total value of QALYs lost is estimated at €61.4 billion Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 8

10. QALYS LOST BY NEW AND PRIOR FRACTURES Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 9 Prior vertebral fractures 16% Incident hip fractures 12% Incident vertebral fractures 14% Incident forearm fractures 1% Incident «other» fractures 17% Prior hip fractures 40%

11. FRACTURE BURDEN TO RISE BY 22% WITH AGEING OF POPULATION Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 10 20102025% increase People with osteoporosis 27.5 million33.9 million23 Number of fractures3.5 million4.5 million28 Number of QALYs1.2 million1.4 million20 Total cost98 billion €121 billion €22

12. UPTAKE OF OSTEOPOROSIS TREATMENTS  Since 2001, considerable increase of the treatment uptake, but slight decrease recently  Alendronate is the most prescribed drug (~ a quarter of the total value of sales) 11 Sales in €/100 population Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

13. UPTAKE OF OSTEOPOROSIS TREATMENTS  Uptake of individual treatments differs between regions. Usually Southern Europe has a higher uptake  An example with Ibandronate 12 Northern EuropeSouthern Europe Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

14. LARGE TREATMENT GAP NEEDS TO BE ADDRESSED Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 13 Conservative estimate: Only 59% of men and 57% of women are treated compared to the proportion of the population that could be considered eligible for treatment based on their fracture risk.

15. www.iofbonehealth.org 13CA071 Service uptake – treatment gap Treatment gap (%) 0 20 40 60 80 100 Spain Ireland Hungary Greece Portugal France Luxembourg SloveniaBelgium Slovakia Austria Denmark UK Italy Netherlands Finland SwedenCzech Germany PolandRomania Latvia Estonia Lithuania Bulgaria EU27 Moderate High Very high

16. PROBLEMS IDENTIFIED  Approved treatments (BPs, SrR, Rlx, Dmab, PTH) are widely available, but their use is restricted by reimbursement policies and guidelines  Compliance and persistence to treatments are poor  Marked variation in DXA availability between countries  Need for fracture liaison services for secondary prevention of fractures Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 15

17. MEDICAL INNOVATION – WE HAVE THE EVIDENCE AND THE TOOLS….  Fracture prevention with alendronate is cost-effective  Other treatments are cost-effective compared to no treatment  BMD assessment is an essential tool for diagnosis, risk prediction and targeting for treatment, and monitoring of treatment  FRAX model estimates the probability of fracture and available for 16 countries – and numbers are growing Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 16

18. Thank you Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 17