Osteoporotic fractures continue to rise due to rapid population aging. By 2025, the number of hip and spine fractures due to osteoporosis is expected to increase by 140 percent. Osteoporotic fractures, typically associated with osteoporosis, are a common geriatric condition.

Osteoporosis is a condition in which bone strength decreases, increasing the risk of bone fracture. When fractures occur in older adults, essential activities, such as standing and walking, become challenging, and quality of life declines. It also directly impacts mortality, increasing a one-year postoperative mortality rate of up to 36 percent for hip fracture patients. Osteoporotic fractures have similar socioeconomic impacts.

The five-year societal cost of osteoporotic fractures in people 65 and older is 1.016 trillion won ($776.6 million). Older adults who suffer osteoporotic fractures are less able to work due to reduced mobility, which, in turn, leads to a decrease in economic participation among the elderly.

The productivity of older adults is an indispensable factor in the super-aged society that we will soon face. It will be easier to find working older adults than working youngsters in the future. This means that mobility and activity will be critical to the workforce, men or women and young or old. It is essential to protect the mobility of older adults by preventing osteoporotic fractures.

Preventing fractures through continuous treatment of osteoporosis is essential, primarily because once a fracture occurs, the risk of recurrence increases up to 10 times. When I explain the treatment process to osteoporosis patients in my clinic, I always emphasize that the ultimate goal of osteoporosis treatment is to “prevent fractures.”

In Korea, however, the reimbursement standards for osteoporosis drugs do not keep with clinical reality, making it challenging to provide effective and continuous treatment for osteoporosis, which, in turn, is a significant obstacle to fracture prevention. Korean patients lose insurance benefits if their T-score rises slightly above -2.5 after one year of drug treatment.

The human body's bone density peaks in the 30s during the life cycle and continues to decline naturally, especially in women after menopause. Osteoporosis patients need to continue treatment, even if medication improves their T-score. Major international guidelines, including the American Association of Endocrinologists, recommend continuing osteoporosis treatment even if the T-score rises above -2.5.

Suppose a patient's condition improves with treatment, and they have a good prognosis. In that case, treatment is considered adequate, and patients are encouraged to continue. For example, in chronic diseases like hypertension and diabetes, benefits do not stop when blood pressure and blood sugar levels improve after treatment. That’s because stopping treatment too soon can cause the figures to return to pre-treatment levels.

More importantly, Korea is the only country worldwide that limits the duration of osteoporosis medication based on T-score. Other countries, including the U.K., Australia, and Canada, guarantee continuous treatment for osteoporosis without limiting the duration of medication.

In the last decade, the level of bone mineral density that can be achieved through treatment has increased. The treatment goals have become more ambitious due to the emergence of good new drugs, including denosumab, which has been proven in clinical studies to increase long-term bone mineral density and reduce fractures.

Unfortunately, patients are discontinuing fracture prevention treatments due to inadequate reimbursement, despite the availability of new drugs that have been effective even with one administration every six months.

Despite the recent strengthening of coverage for various diseases, the reimbursement standards for osteoporosis drugs in Korea have not changed in the past decade. The last time the duration of osteoporosis treatment for patients with a T-score of -2.5 or less was improved was in 2013.

When a fracture occurs, the medical costs of surgery, hospitalization, and nursing care for the patient and the financial loss and physical pain of caregiving for the patient's family are considerable.

In addition, as the population aging proceeds, the financial costs of health insurance and long-term care insurance will increase, adversely affecting the overall insurance finances. Therefore, it is crucial to recognize that an effective response to the various health problems of older adults the nation will inevitably face is fracture prevention.

To prevent osteoporotic fractures, it is necessary to provide continuous benefits to increase bone density to a sufficient level. True, we must also consider the realities of health insurance finance. A policy solution would be to continue the benefit for at least three years, regardless of T-score changes, considering the enhancement of the insurance’s sustainability.

The foremost goal of osteoporosis treatment is to prevent fractures. The continued reimbursement of osteoporosis treatment will reduce the burden on patients and society and serve as a driving force for creating healthier individuals and society.