The number of osteoporosis-related fractures is set to rise considerably over the next few decades due to the increase in the number of elderly patients at high risk of falls and fractures. Despite progress, few patients receive appropriate treatment for osteoporosis, even after a fracture. The osteoporosis treatment crisis is linked to a number of factors, including the fears and beliefs of patients and doctors. Strategies to deal with this crisis represent a considerable challenge. We are proposing 3 projects in response to the lack of treatment

Improving the identification of subjects at risk of fracture: the CROSS (Consequences and Risks of Severe Osteoporosis) cohort is the first French cohort of 913 patients hospitalised for severe osteoporotic fractures in 12 French centres. The aim of this cohort is to identify the risk of refracture and death in the short term, and to assess the effect of management on this risk.

Improving osteoporosis screening through opportunistic screening: the OPPORTOS project is a large-scale study, based on the opportunistic use of abdominal and spinal scans performed for any medical reason, and available on the APHP’s PACS, which enable analysis of bone parameters on the spine, and detection of vertebral fractures, automatically, and therefore without additional radiation, time or cost. These data will be analysed in conjunction with PMSI/SNDS (Health Data Hub) data, in order to prospectively assess the incidence of fractures, and determine relevant thresholds for diagnosis and therapeutic decisions. These analyses are based on 150,000 scans. This opportunistic imaging strategy could also use dental panoramas to identify subjects with osteoporosis. The PANOSTEO project is developing a biomarker for osteoporosis based on the analysis of dental panoramas. This collaboration between the team of dentists (Université Paris Cité, F Tilotta, ECAMO researcher in 2023) is particularly interesting because there is a link between osteoporosis and dental condition.

– evAB project: The aim of this project is to improve the care pathway for patients suffering from fractures by setting up a connected care pathway for fractures (e-Fracture Liaison Service). We propose to set up a post-fracture care pathway using an automatic detection tool to identify fractures and a platform for post-fracture management (e-FLS). The effectiveness of the e-fracture pathway will be compared with the conventional pathway in a prospective multicentre French study of patients aged over 50 hospitalised for a recent fracture (evAB study).

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