Time to reframe osteoporosis: a position statement to characterize the osteoporosis care gap

Osteoporosis, a condition marked by increased fracture risk, remains under-diagnosed and under-treated worldwide, resulting in a substantial "treatment gap"-the difference between those eligible for osteoporosis treatment and those who actually receive it. While the concept of closing the treatment gap is commendable, and has galvanized clinical and policy efforts, this position statement argues that the prevailing narrative is in danger of becoming disease-focused and parentalistic, neglecting person-centered care. An international consensus group, including public contributors with lived experience were convened to define and characterize the "osteoporosis care gap" as a broader framework, encompassing deficits not only in pharmacological treatment but also in diagnosis, assessment, and multi-disciplinary management. The care gap is thus defined as "the discrepancy between the care provided to those at risk of osteoporotic fractures and best practice, person-centered care<i>.</i>" Multi-level determinants of the care gap are identified including: societal-low public awareness underpinned by unhelpful stereotypes, and prevalent health inequalities; health policy-insufficient prioritization, diagnostic confusion, and lack of incentivization; healthcare service-fragmented care pathways with unclear roles and poor communication, inadequate follow-up, and insufficient support for shared decision making; and individual-unmet needs for care which is person-centered, participatory, understandable, equitable, holistic and multidisciplinary, and respects autonomy. The statement calls for a person-centered, equitable, and multidisciplinary approach to osteoporosis care, integrating the perspectives and needs of patients, families, and caregiver. Actions needed at societal and policy level are described, including increasing public awareness, increasing health policy prioritization, with clear professional leadership. The components of osteoporosis care are described in terms of case finding, assessment, treatment, and review. Addressing this, care gap requires coordinated efforts from policymakers, healthcare services, and professionals, with a renewed focus on equity and patient values and preferences.