Barriers and solutions for global access to osteoporosis management: A position paper from the international osteoporosis foundation

Authors: HARVEY, NICHOLAS - University Of Southampton; AL-DAGHRI, NASSER - King Saud University; BEAUDART, CHARLOTTE - University Of Namur; BRANDI, MARIA - Firmo Foundation; BURLET, NANSA - University Of Liege; CAMPUSANO, CLAUDIA - Universidad De Los Andes; CAVALIER, ETIENNE - University Of Liege; CHANDRAN, MANJU - Singapore General Hospital; COOPER, CYRUS - University Of Southampton; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; HALBOUT, PHILIPPE - International Osteoporosis Foundation; HOUGH, TEREZA - National Osteoporosis Foundation Of South Africa; LAZARETTI, MARIS - Federal University Of Sao Paulo; MATIJEVIC, RADMILA - University Of Novi Sad; MITHAL, AMBRISH - Institute Of Diabetes And Endocrinology Max Healthcare; NJEZE, NGOZI - University Of Nigeria; RIZZOLI, RENE - Geneva University Hospital; SALEH, YOUSEF - Health Oasis Hospital Riyadh; KANIS, JOHN - University Of Sheffield Medical School; WARD, KATE - University Of Southampton; MCCLOSKEY, EUGENE - University Of Sheffield

Submitted to: Osteoporosis International
Publication Type: Review Article
Publication Acceptance Date: 7/10/2025
Publication Date: 8/22/2025
Citation: Harvey, N.C., Al-Daghri, N., Beaudart, C., Brandi, M.L., Burlet, N., Campusano, C., Cavalier, E., Chandran, M., Cooper, C., Dawson-Hughes, B., Halbout, P., Hough, T., Lazaretti, M., Matijevic, R., Mithal, A., Njeze, N., Rizzoli, R., Saleh, Y., Kanis, J.A., Ward, K., Mccloskey, E.V. 2025. Barriers and solutions for global access to osteoporosis management: A position paper from the international osteoporosis foundation. Osteoporosis International. https://doi.org/10.1007/s00198-025-07628-5.
DOI: https://doi.org/10.1007/s00198-025-07628-5

Interpretive Summary:

Technical Abstract: Our ability to optimally manage bone health across the lifecourse, and so minimise the risk of fractures, has advanced substantially in recent decades. Whilst fragility fractures and osteoporosis were historically viewed simply as inherent in normal ageing, they are now recognised as manifestations of age-related disease. Key to advancing the field was the development of the conceptual (relating to impaired bone mass and microarchitecture with increased propensity to fracture), and subsequent World Health Organization densitometric, definitions of osteoporosis, cementing the role of dual-energy x-ray absorptiometry in bone health management. However, whilst low bone mineral density is a strong risk factor for fracture, many individuals who do fracture have normal or only modestly reduced bone mineral density. Furthermore, the existence of two definitions constituting a condition called "osteoporosis", one based on a measurement, and the other conceptual, has led to uncertainty in clinical practice. The field is therefore moving towards calculation of an individual's absolute fracture risk, based on clinical risk factors, with the option to incorporate bone mineral density (if available) as a risk factor rather than as an indication for treatment. Uptake of this new direction has been variable internationally, with many parts of the world, particularly low- and middle-income countries, still predicating treatment (where osteoporosis services exist) on bone mineral density, despite poor availability of densitometry in many such settings. In this Position Paper, on behalf of the International Osteoporosis Foundation, we review the current barriers which prevent equitable access to optimal bone health management worldwide and recommend potential solutions which might be implemented to overcome them.