Osteoporosis Treatment Gap After Fragility Fracture | Market Intelligence

Description

List of Tables

Japan records a very large number of fragility fractures each year, and what happens after them is one of the country's most persistent quality failures. A fragility fracture is the strongest available signal that a patient has osteoporosis and faces elevated risk of the next fracture; guidelines are unambiguous that treatment should follow. Yet the great majority of patients receive no osteoporosis therapy after their fracture, continuation rates among those who do start are poor, and fractures have risen to become one of the leading causes of long-term-care need certification. The gap between what the evidence prescribes and what the system delivers defines the market.

The causes are structural rather than clinical. The orthopedist who fixes the fracture is not responsible for the bone disease that caused it; the primary-care physician who is responsible often never learns the fracture occurred. No actor in the standard pathway owns secondary prevention, reimbursement has only recently begun to pay for coordination, and the therapeutic armamentarium, from bisphosphonates and eldecalcitol to denosumab, teriparatide, abaloparatide, and romosozumab, requires sequencing decisions that diffuse responsibility further. The result is a treatment gap that is simultaneously a public-health failure and a commercial opening.

This report quantifies and anatomizes the gap. It reconstructs the post-fracture pathway in Japanese hospitals and communities, identifies each hand-off where patients exit treatment, and maps the guideline framework from the Japanese osteoporosis societies against actual practice. It profiles the therapeutic landscape in detail: Amgen's Prolia and Evenity, Lilly's Forteo, Asahi Kasei's teriparatide acetate, Teijin's Ostabalo, Chugai's Edirol, Daiichi Sankyo's minodronic acid, legacy bisphosphonates, and the incoming denosumab biosimilars from Sandoz, Samsung Bioepis, and Fresenius Kabi. It then examines the institutional responses, fracture liaison services, coordinator models, and the April 2022 reimbursement changes, and compares Japan's gap with US, EU5, and Chinese performance.

The report serves osteoporosis franchise owners planning patient-find and persistence programs, hospital groups evaluating secondary-prevention services, orthopedic device makers whose customers face the consequences, payers modeling fracture-driven costs, and investors assessing the adherence and care-coordination segment. It is built to move readers from the size of the problem to the specific points where intervention changes it.

Scope and Coverage

The report covers fragility-fracture epidemiology, post-fracture treatment pathways, the pharmacotherapy landscape, and secondary-prevention service models across the US, EU5, Japan, and China. It addresses treatment gaps, continuation, and coordination economics rather than primary-fracture surgical technique. Fracture liaison service economics are treated in depth in a companion report.

Report Highlights

Post-fracture pathway reconstruction with every treatment-exit point identified
Guideline framework versus actual prescribing practice in Japan
Full osteoporosis pharmacotherapy landscape including biosimilar entrants
Treatment-continuation analysis and its structural causes
Secondary-prevention service models and the 2022 reimbursement changes
International comparison of post-fracture treatment performance

Product Code: JPH-010

Table of Content

1. Executive Summary

2. Osteoporosis Treatment Gap After Fragility Fracture: Overview and Clinical Background

3. Epidemiology and Patient Population: US, EU5, Japan, and China

4. Current Treatment Landscape and Standard of Care

5. Pipeline and Development Activity

6. Regulatory Pathways: FDA, EMA, PMDA, and NMPA Considerations

7. Reimbursement and Pricing Analysis with a Focus on Japan's NHI System

8. Competitive Landscape and Key Companies

9. Unmet Needs and Commercial Opportunities in Japan

10. Appendix: Methodology and Sources

Companies Mentioned

Amgen (US) - Prolia (denosumab) and Evenity (romosozumab) osteoporosis franchise
UCB (BE) - romosozumab co-commercial partner outside Japan
Eli Lilly (US) - Forteo (teriparatide) anabolic benchmark
Asahi Kasei (JP) - teriparatide acetate and domestic osteoporosis presence
Astellas (JP) - legacy osteoporosis partnerships in Japan
Teijin (JP) - Ostabalo (abaloparatide) in Japan, licensed from Radius Health
Hikma (UK) - teriparatide biosimilars and injectable generics
Chugai (JP) - Edirol (eldecalcitol) active vitamin D3 franchise
Daiichi Sankyo (JP) - minodronic acid (Bonoteo/Recalbon) bisphosphonates
Sandoz (CH) - denosumab biosimilars (Jubbonti/Wyost) for price-sensitive markets
Samsung Bioepis (KR) - denosumab biosimilar pipeline
Fresenius Kabi (DE) - denosumab biosimilar entrant
Organon (US) - Fosamax generic legacy bisphosphonates

Product Code: JPH-010

List of Tables

Table 1. Osteoporosis and fragility fracture: clinical definitions and risk framework
Table 2. Fracture-site taxonomy: hip, vertebral, wrist, and other fragility fractures
Table 3. Secondary-fracture risk framework and the imminence concept
Table 4. Milestones in Japanese osteoporosis policy and guidelines by year
Table 5. Fragility-fracture population structure by site, age, and sex
Table 6. Hip-fracture care pathway: admission, surgery, rehabilitation, and discharge
Table 7. Vertebral-fracture identification gap: incidental and asymptomatic presentations
Table 8. Fracture linkage to care-need certification under the LTCI system
Table 9. Post-fracture mortality and dependency frameworks
Table 10. Japanese osteoporosis guidelines: society positions on post-fracture treatment
Table 11. FRAX and Japanese fracture-risk assessment tools in practice
Table 12. Bone-density testing infrastructure: DXA access in Japanese hospitals
Table 13. Calcium, vitamin D, and eldecalcitol (Edirol) baseline therapy positioning
Table 14. Current prescribing practice after fracture: pathway audit structure
Table 15. Bisphosphonate landscape: minodronic acid (Bonoteo/Recalbon) and legacy alendronate and risedronate
Table 16. Denosumab (Prolia): positioning, dosing logistics, and discontinuation-risk management
Table 17. Romosozumab (Evenity): anabolic-antiresorptive sequencing role
Table 18. Teriparatide products: Forteo and Asahi Kasei teriparatide acetate
Table 19. Abaloparatide (Ostabalo, Teijin): Japanese development and positioning
Table 20. Denosumab biosimilars: Sandoz, Samsung Bioepis, and Fresenius Kabi entrants
Table 21. Teriparatide biosimilars and injectable generics: Hikma and peers
Table 22. Drug-sequencing frameworks across anabolic and antiresorptive classes
Table 23. PMDA and international regulatory status of osteoporosis therapies
Table 24. NHI pricing structure for osteoporosis pharmacotherapy
Table 25. April 2022 reimbursement changes for post-fracture management
Table 26. Hospital fee structures relevant to secondary-fracture prevention
Table 27. LTCI cost interface with fracture-driven care need
Table 28. US and EU5 reimbursement for post-fracture programs
Table 29. China osteoporosis treatment access environment
Table 30. Fracture liaison service models: coordinator-based secondary prevention
Table 31. IOF Capture the Fracture program and Japanese site participation
Table 32. Hospital archetypes operating secondary-prevention services
Table 33. Pharma patient-support programs: Amgen and peer company structures
Table 34. Amgen: Prolia and Evenity franchise structure in Japan
Table 35. UCB: romosozumab partnership role outside Japan
Table 36. Lilly and Asahi Kasei: teriparatide franchise positions
Table 37. Teijin, Chugai, and Daiichi Sankyo: domestic osteoporosis portfolios
Table 38. Biosimilar sponsors and their Japan entry structures
Table 39. Astellas legacy positions and partnership history in osteoporosis
Table 40. Hospital-group strategies for post-fracture programs
Table 41. Orthopedic-device maker interests in the fracture-care pathway
Table 42. Primary-care engagement structures in secondary prevention
Table 43. Unmet needs: ownership gaps in the post-fracture pathway
Table 44. Treatment-exit points and their causes: hand-off analysis
Table 45. Continuation-improvement program designs and components
Table 46. Commercial opportunities in patient-find and persistence services
Table 47. Hospital business-case framework for secondary prevention
Table 48. Policy agenda: guideline implementation and reimbursement levers
Table 49. Report methodology: claims-data frameworks, literature, and interview base
Table 50. Glossary of fracture, therapy, and program terms

List of Figures

Figure 1. Fragility-fracture clinical framework diagram
Figure 2. Fracture-site taxonomy map
Figure 3. Secondary-fracture risk and imminence schematic
Figure 4. Timeline of Japanese osteoporosis policy and guidelines
Figure 5. Fracture population structure framework
Figure 6. Hip-fracture care pathway flow
Figure 7. Vertebral-fracture identification gap schematic
Figure 8. Fracture-to-care-need linkage diagram
Figure 9. Post-fracture outcome pathway framework
Figure 10. Guideline-position map across osteoporosis societies
Figure 11. Fracture-risk assessment tool landscape
Figure 12. DXA access map in Japanese hospitals
Figure 13. Baseline-therapy positioning: calcium, vitamin D, and eldecalcitol
Figure 14. Post-fracture prescribing pathway audit flow
Figure 15. Bisphosphonate landscape map
Figure 16. Denosumab positioning and discontinuation-risk pathway
Figure 17. Romosozumab sequencing role schematic
Figure 18. Teriparatide product landscape
Figure 19. Abaloparatide development and positioning diagram
Figure 20. Denosumab biosimilar entrant map
Figure 21. Teriparatide biosimilar and generic landscape
Figure 22. Anabolic-antiresorptive sequencing framework
Figure 23. Regulatory status map for osteoporosis therapies
Figure 24. NHI pricing structure diagram for the class
Figure 25. April 2022 reimbursement change flow
Figure 26. Hospital fee structure map for secondary prevention
Figure 27. LTCI cost interface with fracture-driven care
Figure 28. US and EU5 reimbursement comparison
Figure 29. China access environment map
Figure 30. Fracture liaison service operating model
Figure 31. Capture the Fracture program structure and Japanese sites
Figure 32. Hospital archetype map for secondary prevention
Figure 33. Pharma patient-support program architecture
Figure 34. Amgen franchise structure in Japan
Figure 35. UCB partnership role diagram
Figure 36. Lilly and Asahi Kasei teriparatide positions
Figure 37. Teijin, Chugai, and Daiichi Sankyo portfolio map
Figure 38. Biosimilar sponsor Japan entry structures
Figure 39. Astellas legacy position diagram
Figure 40. Hospital-group strategy map for post-fracture programs
Figure 41. Device-maker interest map in fracture care
Figure 42. Primary-care engagement structure diagram
Figure 43. Ownership-gap map in the post-fracture pathway
Figure 44. Treatment-exit point analysis schematic
Figure 45. Continuation-improvement program design components
Figure 46. Patient-find and persistence opportunity map
Figure 47. Hospital business-case framework diagram
Figure 48. Policy lever map: guidelines and reimbursement
Figure 49. Methodology flow: claims frameworks, literature, interviews
Figure 50. Data cut-off and update cadence schematic

Osteoporosis Treatment Gap After Fragility Fracture | Market Intelligence | US, EU5, Japan & China

Description

Table of Contents

List of Tables

Table of Content

1. Executive Summary

2. Osteoporosis Treatment Gap After Fragility Fracture: Overview and Clinical Background

3. Epidemiology and Patient Population: US, EU5, Japan, and China

4. Current Treatment Landscape and Standard of Care

5. Pipeline and Development Activity

6. Regulatory Pathways: FDA, EMA, PMDA, and NMPA Considerations

7. Reimbursement and Pricing Analysis with a Focus on Japan's NHI System

8. Competitive Landscape and Key Companies

9. Unmet Needs and Commercial Opportunities in Japan

10. Appendix: Methodology and Sources

Companies Mentioned

List of Tables

List of Figures