Summary

Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture. The high treatment gap in our cohort consisted of unselected volunteer patients highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment.

Introduction

Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture, with a treatment gap around 80%. This can have dramatic consequences for patients and the healthcare systems.

Methods

In this study based on longitudinal data from the FRISBEE (Fracture RIsk Brussels Epidemiological Enquiry) cohort of 3560 volunteer women aged 60 to 85 years, we evaluated the 1-year treatment gap after a first major incident fragility fracture.

Results

There were 386 first validated fragility fractures, 285 major osteoporotic fractures (MOF) and 101 “other major” fractures. The rate of untreated patients was 85.0% (82.8% for MOF versus 91.0 % for “other major” fracture sites) (p = 0.04), with a lower rate for spine (70.5%) and hip (72.5%) versus shoulder (91.6%) and wrist (94.1%) (p < 0.0001). More specifically, the treatment gap for patients with osteoporosis, defined by a T-score < − 2.5 SD was 74.6% versus 76.5% for patients with osteoporosis defined by the presence of hip, shoulder, or spine fractures, independently of DXA results. When considering age groups, the rate of untreated women was 87.9% for women 60–70 years old, 88.2% between 70 and 80 years and 77.8% above 80 years (p = 0.03), with a greater difference between women who were younger or older than 80 years at inclusion: 88.1% versus 77.8% (p = 0.009). A diagnosis of osteoporosis (p = 0.01) and age (p = 0.03) were the only clinical risk factors (CRFs) significantly associated with treatment initiation.

Conclusions

This study highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment.

中文翻译：

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预期志愿者人群中骨质疏松治疗的差距

概要

尽管可获得预防骨质疏松性骨折的有效药物，但只有少数女性在骨折后接受骨质疏松治疗。在我们的队列中，由未选出的自愿患者组成的治疗差距很大，这凸显了迫切需要进行额外教育的培训，尤其是对于医学专业而言，要有更高的治疗风险-收益平衡。

介绍

尽管有预防骨质疏松性骨折的有效药物，但只有少数女性在骨折后接受骨质疏松症治疗，治疗差距约为80％。这可能对患者和医疗系统产生重大后果。

方法

在这项研究的基础上，根据FRISBEE（布鲁塞尔裂口流行病学研究）队列的3560名年龄在60至85岁之间的女性志愿者的纵向数据，我们评估了首次重大事件脆性骨折后的1年治疗间隔。

结果

首先确认了386例脆性骨折，285例主要骨质疏松性骨折（MOF）和101例“其他主要”骨折。未经治疗的患者比例为85.0％（MOF为82.8％，“其他主要”骨折部位为91.0％）（p  = 0.04），脊柱（70.5％）和髋部（72.5％）相对于肩部（91.6）更低％）和手腕（94.1％）（p  <0.0001）。更具体地说，由T评分<-2.5 SD定义的骨质疏松患者的治疗缺口为74.6％，而由髋部，肩部或脊柱骨折的存在所定义的骨质疏松患者的治疗缺口为76.5％，而与DXA结果无关。在考虑年龄组时，未治疗的女性比例为60-70岁的女性为87.9％，70至80岁的女性为88.2％，80岁以上的女性为77.8％（p = 0.03），年龄在80岁以下的女性之间的差异更大：88.1％对77.8％（p  = 0.009）。骨质疏松症（p  = 0.01）和年龄（p  = 0.03）的诊断是与治疗开始显着相关的唯一临床危险因素（CRF）。

结论

这项研究强调了迫切需要进行额外的教育，尤其是对于医学专业而言，需要更多的治疗风险与收益的平衡。