Osteoporotic fractures are a major public health concern. Fragility fractures result in serious disability, impacting quality of life, and mortality risk. Understanding fractures is important for creating successful interventions to reduce fracture risk and improve the delivery of skeletal health care. Further, as the population ages the increasing prevalence of fragility fractures is a growing economic issue.
It is well understood that women and men have anatomically and physiologically different bone structures. With age, women have a higher incidence of fragility fractures than men but men are twice as likely to die following an osteoporotic-fracture. Gender influence is also evident in other skeletal conditions including osteopenia, Paget’s disease of bone, osteoarthritis and osteosarcoma. In the UK, there have been several attempts to shift from population to individual based therapeutic approaches. The aim would be to have more personalised treatments that would provide more effective treatment options for women and men.
However, the translation of personalised medicines from laboratories to the clinic is challenged at pre-clinical stage by historic sex bias, whereby laboratories favour one sex for their experiments. This bias translates to clinics where drugs studied and optimised for women with osteoporosis for example are given to men.
Improve understanding of public health professionals around the sex differences which underlie skeletal health and treatment efficacy.
Prioritise the development of personalised, sex-specific medicines and therapy for bone healt.
Influence research policy to standardise experimental design and reporting of sex to avoid preclinical sex bias.
Men and womens bones are biologically different throughout life. Most skeletal diseases also impact women and men differently.
Fragility fractures are most common in women aged over 50 but also affect men, and occur as the result of age-related bone loss known as osteoporosis. The incidence of fractures are predicted to increase by 33% in men and 23.4% in women by 2030.
An estimated 536,000 new fragility fractures are sustained in the UK each year. In 2011, fragility fractures were estimated to cost £2.3 billion in the UK, a burden expected to increase to more than £6 billion by 2036.
The majority of costs relate to hip fracture, which nearly always results in hospitalisation, causing around 1,100 deaths each month in the UK. Men with hip fractures have a mortality rate two to three times higher than women.
Men receive treatments for age-related bone loss that have been developed using female preclinical models which may not be optimal for male physiology resulting in a health inequality.
Using preclinical models, new sex-specific drug targets are being identified which could enable personalised therapies to be developed to address skeletal health inequalities evidenced with gender and intersections including age and ethnicity.
Dr Claire Clarkin: School of Biological Sciences, University of Southampton
Dr Valentina Cardo: Winchester School of Art, University of Southampton
Dr Aikta Sharma: School of Biological Sciences, University of Southampton
Professor Julie Greeves: Army Health and Performance Research, Ministry of Defence