On behalf of the global osteoporosis and bone health community, the International Osteoporosis Foundation (IOF) expresses serious concern that the Zero Draft of the Political Declaration for the UN High-Level Meeting on Non-Communicable Diseases (NCDs) and Mental Health makes essentially no reference to chronic musculoskeletal conditions, including osteoporosis and related fragility fractures, despite their substantial impact on individuals, health systems, and societies. 

Musculoskeletal health is vital for maintaining physical activity, independence, and overall well-being throughout the lifespan. It constitutes a fundamental aspect of intrinsic capacity, which is essential for healthy ageing. 

Extensive evidence highlights the significant burden posed by musculoskeletal disorders—particularly osteoporosis and associated fragility fractures—which represent a common and major cause of morbidity and premature mortality worldwide:

• Using the WHO definition, osteoporosis affects approximately 21.2% of women and 6.3% of men over the age of 50 globally.  This makes osteoporosis among the most common chronic non communicable diseases, affecting approximately 500 million men and women worldwide.
• Osteoporosis is the leading cause of fragility fractures, which result in pain, disability, loss of independence, and premature death—particularly among older adults.
• The WHO recognizes osteoporosis as a chronic non-communicable disease, and specifically highlights osteoporosis as an important condition contributing to disability, reduced quality of life and mortality in its World Report on Ageing and Health.
• Fragility fractures are the fourth leading cause of chronic disease morbidity in Europe, after ischemic heart disease, dementia and lung cancer, and before chronic obstructive pulmonary disease and ischemic stroke.
• The combined lifetime risk for major osteoporotic fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease. In men, the lifetime risk of fragility fracture is greater than that of prostate cancer.
• Musculoskeletal conditions are the most common cause of chronic pain. For example, back pain resulting from vertebral fractures, which can be severely debilitating, contributes significantly to life-years with disability. Osteoarthritis, the most common joint disorder, affects more than half of individuals over 60 years old, with immense impact on wider health, mobility, independence and quality of life.
• Early mortality attributed to fragility fractures should be highlighted. The overall mortality is about 20% in the first 12 months after hip fracture and is higher in men than in women. A 50-year-old woman from the US has a 2.8% risk of death related to hip fracture during her remaining lifetime, equivalent to her risk of death from breast cancer and four times higher than that from endometrial cancer.
• With global population expansion, and a shift towards an older demographic, particularly in low-to-middle income countries, it is estimated that fracture numbers will increase dramatically worldwide in the coming decades.
• Osteoporosis and related fragility fractures impose a significant socio-economic burden, leading to substantial work loss and increased demands on families, society, and social care systems.

Call for inclusion of osteoporosis and musculoskeletal health in the Declaration

The IOF commends the ongoing global efforts to tackle noncommunicable diseases and mental health, and strongly supports the draft declaration’s strong focus on reducing tobacco use, harmful use of alcohol, and unhealthy diets, all of which are modifiable risk factors for musculoskeletal conditions and osteoporosis specifically.

However, we draw attention to the incomplete coverage of the Zero Draft, which omits mention of musculoskeletal conditions. As a whole, these conditions, and specifically fragility fractures due to osteoporosis, contribute significantly to years lived with disability and early mortality, and should be specifically mentioned in the Declaration. 

The Declaration is a pivotal opportunity to prioritize such musculoskeletal conditions in global health policy. Reducing the impact of musculoskeletal diseases will not only reduce suffering and health costs but also support mental health, mobility, and wellbeing across the life course. 

IOF, representing a global community of more than 340 patient and medical organizations in 152 countries, calls for the explicit inclusion of musculoskeletal diseases, and specifically osteoporosis, in the Declaration. Addressing musculoskeletal disorders such as osteoporosis is central to an integrated approach to NCD prevention and control, and in support of healthy ageing.

View IOF’s specific comments on the Zero Draft

IOF urges national patient and medical organizations in the field to contact policymakers and health ministries in their respective countries to express their concern.