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Contact: Mary Anderson, IOF or
Fiona McMillan, Cohn & Wolfe
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'Too Little Too Late?': International Survey Shows Bone Loss Not Being Detected Early Enough To Protect Women From Osteoporotic Fractures

IOF and Researchers Issue Call to Action to Women, Physicians and Health Authorities

Chicago, 16 June, 2000: A first-of-its-kind-survey (PDF file, 1.2 MB), conducted by the International Osteoporosis Foundation (IOF) and presented today in conjunction with the IOF World Congress on Osteoporosis, revealed that despite the vast progress made in osteoporosis research and education over the last decade, bone loss is still not being detected early enough to protect postmenopausal women from osteoporosis-related fractures. The survey findings, presented in a report entitled, 'How Fragile is Her Future?', indicate that although physicians recognise the importance of preventing a first fracture in postmenopausal women, significant barriers exist that limit their ability to intervene in time to prevent the first and subsequent fractures1. Fractures were recognised as the most serious consequence of osteoporosis, resulting in a significant negative impact on women's daily living and long-term health.

"We have made substantial progress in terms of identifying risk factors, bringing to market new technologies to aid diagnosis, and developing medicines that fight osteoporosis, but this survey clearly illustrates that current patient-doctor communication about osteoporosis prevention and treatment is inadequate and falls short of its goal." said Pierre D Delmas, M.D., PhD, President, International Osteoporosis Foundation. "Although nearly 100% of doctors and women recognise that osteoporosis is a serious health threat, women appear to be leaving the doctor's office with a limited understanding of their personal risk, and as a result, are doing very little to protect their bones. Much work remains to be done by women and doctors alike."

Conducted by the international research firm IPSOS for the IOF, the survey questioned 1,071 physicians and 559 postmenopausal women (some who suffer from osteoporosis) from 11 different countries, about their attitudes and current approach to the prevention and treatment of osteoporosis.

Women's understanding of their personal risk is alarmingly low

Although one in two postmenopausal women will be affected by osteoporosis during her lifetime2, a surprising 85% do not believe they are personally at risk of developing the disease. Furthermore, while 65% of doctors reported that they routinely conduct health status reviews among their postmenopausal patients, only 20% of women recalled being screened for osteoporosis.

Even among those women suffering from osteoporosis, 80% admitted they were not aware of their risk factors prior to diagnosis and disturbingly, a third of these women reported that they are not currently taking medication to prevent fractures related to the disease. When asked how the disease affected them, 81% said that osteoporosis has had a negative impact on their quality of life, causing pain and loss of mobility.

Medication to prevent fractures is not being offered to women early enough

Doctors overwhelmingly (96%) acknowledged that osteoporosis is a serious condition that merits discussion and attention with their postmenopausal patients, with 97% stating that prevention of the first fracture was their management goal. Despite this, only 2% of women who talked about osteoporosis with their doctors recalled discussing prescription medications with their physician. In addition, doctors often screen for osteoporosis or prescribe medication only after evidence that a fracture exists and 80% of physician respondents stated that one of the strongest indicators of an ideal candidate for a medication is a woman who has already suffered a vertebral fracture.

Doctors indicated several obstacles to effective diagnosis and prevention, including inadequate levels of access to bone mineral density testing (75%) and lack of funding for bone densitometry equipment and facilities (85%). In addition, 60% of physicians believe that postmenopausal women do not consult them early enough, and 61% of physicians say some of their patients have refused preventive and treatment medications due to concerns about the long-term safety of medication.

Gap Exists Between Women's and Doctors' Perceptions About Osteoporosis Medication

Physicians estimate that they prescribe preventive or treatment medications to more than 80% of postmenopausal patients, but 63% of the women surveyed said that they were not taking any medication to prevent or treat osteoporosis. Side-effects were women's main concern when deciding whether or not to take a preventative or treatment medication.

According to Ethel S Siris, M.D, Professor of Clinical Medicine, College of Physicians and Surgeons of Columbia University, for most women the benefits of taking osteoporosis medication outweigh the risks. "The decision to take a medication is an individual decision between a woman and her doctor, but we do not want unwarranted fears about side-effects to stand in the way of women getting the fracture protection that they might need," said Siris. She noted that doctors have a responsibility to fully explain the long-term consequences of osteoporosis in a way that women can easily understand, and then work with women to identify a therapy that both provides benefit and addresses their concerns. "The best osteoporosis medication for any woman is one that is not only effective and safe, but one that she will continue to take over the long-term – this is critical to maintain bone mass and prevent fractures," Siris said.

IOF Calls for Stronger Partnership Between Doctors, Health Authorities and Women to Fight Osteoporosis

"This report challenges women, their healthcare providers and government health authorities to make the identification of bone loss a top priority," said Mary Anderson, Executive Director of the IOF. "Minimising fracture risk will result in fewer hospitalisations among postmenopausal women and reduced long-term costs associated with osteoporosis."

The IOF called for several actions in response to the international survey, including greater commitment from doctors to conduct a full health status review, including bone mineral density testing when appropriate; increased governmental provision or public-private partnerships to make bone mineral density tests more widely available; and frank patient-doctor dialogue focussing on discussion of the long-term consequences of osteoporosis and appropriate medications. In addition, the IOF called for women to take the initiative and ask their physician direct questions about the preventative measures they might take.

Detailed survey findings, and a copy of 'How Fragile is Her Future?' can be obtained from Mary Anderson/Susanna Gorga of the IOF on +41 61 731 1482 or from

Notes to Editors

Osteoporosis – a disabling disease

Osteoporosis is a systemic disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, most frequently in the spine (vertebrae), wrist, hip and pelvis3. Bone loss is gradual and may be without symptoms or warning signs. The annual combined medical costs of treating 2.3 million osteoporotic fractures in both Europe and the United States is currently $27 billion4, and it is fast becoming a public health problem around the world.

Survey Methodology

The international survey was conducted by the IOF and made possible through an educational grant from Eli Lilly and Company. Physicians and women polled represented countries from key regions around the world: Australia, Brazil, Canada, France, Germany, Italy, Jordan, Lebanon, Mexico, Spain and the United Kingdom.


  1. Survey of 1,071 physicians and 559 postmenopausal women conducted by IPSOS across 11 countries between March and May 2000.
  2. Chrischilles et al. Arch Intern Med. 1991; 151 2026-2032
  3. International Osteoporosis Foundation. 1998 Annual Report.
  4. International Osteoporosis Foundation. World Osteoporosis Day Factsheet. 1998

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