Table 7.

Examples of diseases associated with bone loss and/or fragility fractures

Disease	Global prevalence (millions)	Evidence for increased risk of bone loss or fractures	Evidence for osteoporosis care gap	Disease specific bone health guidelines
Diabetes	415 [107]	Meta-analyses have shown both Type 1 and Type 2 diabetics to be at increased risk of hip fracture [113, 114]. Relative risk (RR) for Type 1 is 6.3-6.9 and RR for Type 2 is 1.4-1.7 [114].	There is currently a lack of studies on the proportion of diabetics receiving bone health assessment.	No
Chronic obstructive pulmonary disease (COPD)	65 [108]	Systematic literature review established the average prevalence of osteoporosis among COPD patients to be 35% [115]. The prevalence of vertebral fractures is high, ranging from 49-63% dependent on GC use [116].	Among a large cohort (n=12,646) of men with hip fracture in the US Veteran’s Health Affairs system, nearly half (47.6%) had COPD [121]. Osteoporosis was known pre-fracture in only 3% of subjects.	The Netherlands [126]
Diseases of malabsorption	42 (Celiac) [109] 5 (IBDa) [110]	A UK study evaluated fracture risk in people with celiac disease. The overall hazard ratio for any fracture was 1.30 (95% CI, 1.16-1.46), for hip fracture was 1.90 (95% CI, 1.20-3.02), and for ulna or radius fracture was 1.77 (95% CI, 1.35-2.34) [117]. A large cohort (n=6,027) with IBD in Canada had 40% higher fracture incidence than the general population [118].	Studies from Austria [122] and the United States [123] have reported that approximately one quarter of IBD patients underwent BMD testing.	Several national guidelines e.g. UK [127]
Dementia	44 [111]	In the UK, incidence of hip fracture among patients with Alzheimer’s disease is 3 times higher than amongst cognitively healthy peers [119].	Studies from several countries report that osteoporosis is infrequently diagnosed and treated in people living with dementia e.g. Canada. Among a large cohort (n=39,452) treated for osteoporosis, a diagnosis of dementia was a negative predictor of treatment (adjusted Odds Ratio 0.55, 95% CI 0.44-0.69) [124].	No
Rheumatoid arthritis (RA)	17 [112]	A large UK study (n=30,000) compared fracture incidence of RA patients to a control group. The RA patients’ risk of hip fracture and vertebral fracture was increased 2-fold and 2.4-fold, respectively [120].	Studies from several countries report sub-optimal assessment and/or treatment of osteoporosis in RA patients e.g. USA. Less than half of a large cohort (n=9,600) of veterans with RA received preventive treatment for osteoporosis [125].	Several national guidelines and EULAR [128]

^aIBD = Inflammatory Bowel Diseases (i.e. Crohn’s disease and ulcerative colitis)