Towards a cure for osteoporosis: the UK Royal Osteoporosis Society (ROS) Osteoporosis Research Roadmap

Osteoporosis is characterised by decreased bone mass and disruption of bone microarchitecture, resulting in reduced bone strength and increased risk of fracture [1]. Approximately one in two women and one in five men will sustain one or more such fragility fractures (that is, occurring as a result of minimal trauma, for example a simple fall) in their remaining lifetime after the age of 50 years [2,3,4]. In the UK, approximately 549,000 new fragility fractures occur each year, including 105,000 hip fractures, 86,000 clinical vertebral fractures, and 358,000 fractures at other sites [5, 6]. Fragility fractures often result in severe pain, disability, and reduction in quality of life; major fractures, particularly hip and vertebral fractures, are also associated with increased mortality [4]. Fragility fractures impose a huge economic burden on health and social services, with an estimated annual cost to the National Health Service (NHS) in excess of £4.7 billion [5, 6]; across Europe, the cost approaches €55 billion [6].

Despite major advances in the assessment of fracture risk and the development of effective pharmacological interventions to reduce fracture, many studies have documented a large treatment gap with only a minority of high-risk individuals receiving appropriate assessment and treatment [7,8,9,10,11]. Possible reasons for this include inadequate awareness and understanding of osteoporosis among the public and healthcare professionals, fear of adverse effects of drugs used in its treatment, and a lack of coordinated service delivery models for those affected [7]. Thus, it is clear that, in addition to addressing gaps in the understanding of the condition itself, removing barriers to appropriate assessment and treatment for all individuals at high risk of fragility fracture is a major priority.

The ROS Osteoporosis and Bone Research Academy was launched in February 2019 as part of the endowment of a royal title for the Charity, formerly known as the National Osteoporosis Society. The mission of the Academy, to work towards a cure for osteoporosis, is fully aligned with the Charity’s vision of a future without fragility fractures and its four strategic aims of prevention, care, support, and cure. To this end, a Working Group structure was set up to address the themes of: causes and mechanisms; the use of novel technologies in diagnosis and management; and strategies to optimise the effectiveness of fracture risk assessment and treatment. The themes function synergistically and are supported by patient advocates, clinicians and scientists, with administrative and governance support from the ROS. Their outputs are overseen by an Advisory Committee, which reports to the ROS Board of Trustees. The high-level research strategy is set out in the Osteoporosis and Bone Research Academy’s Osteoporosis Research Roadmap (https://view.publitas.com/royal-osteoporosis-society/ros-osteoporosis-research-roadmap-2021/page/1). In this editorial article, we summarise the approach taken to scoping and evaluating the existing literature, developing and planning a portfolio of scientific projects, and critical contribution from patient advocates. Detailed descriptions of individual areas have been published separately (functional genomics [12], opportunistic fracture detection [13]) or are in preparation (currently medication adherence, automated care pathways, osteoporosis screening, microbiome and bone health). The detailed exposition of the prior literature and planned projects is therefore beyond the scope of the overview presented in this editorial article.