Prevalence and treatment of fragility fractures in Spanish primary care: PREFRAOS study,Archives of Osteoporosis

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Prevalence and treatment of fragility fractures in Spanish primary care: PREFRAOS study
Archives of Osteoporosis ( IF 3.1 ) Pub Date : 2022-07-15 , DOI: 10.1007/s11657-022-01124-7
Daniel Martínez-Laguna _{1,

2} , Cristina Carbonell _{2,

3} , José-Carlos Bastida ₄ , Milagros González ₅ , Rafael M Micó-Pérez ₆ , Francisco Vargas ₇ , Mónica Balcells-Oliver ₈ , Laura Canals ₉ ,

Affiliation

Summary

In Spanish primary care (PC), the prevalence of fragility fractures (FF) in subjects ≥ 70 years old is high, especially in women. One-third of subjects with an FF lacked osteoporosis (OP) diagnosis and >50% were not currently receiving OP medication. An improvement of the FF management in this population is needed.

Purpose

In Spanish PC, the prevalence of FF is high, especially in women. One-third of subjects with a FF lacked an OP diagnosis and more than half were not currently receiving OP medication. Several studies reported underdiagnosis/undertreatment of OP in PC among elderly subjects with FF. To date, no such data exist for Spain. The purpose is to estimate the prevalence of FF in the elderly population (≥ 70 years old) and to describe the characteristics, risk factors, comorbidities, and OP diagnosis and treatment rates of subjects with FF in Spanish PC centers.

Methods

This is an observational, retrospective study in Spain consisting of two phases. Phase A included all subjects ≥ 70 years old listed in the center’s medical records from November 2018 to March 2020. Phase B included subjects with FF and prior consultation at the center for any reason. Subjects were excluded only if they had previously participated in another study. Primary outcomes were prevalence of FF (phase A) and characteristics of subjects with at least one FF (phase B).

Results

The overall prevalence of FF was 17.7% among subjects visiting medical centers for any reason (24.1% women vs. 8.0% men) (30 PC centers from 14 Spanish regions). Vertebral (5.1%) was the most prevalent fracture. Of 665 subjects in phase B, most (87%) were women and ≥ 80 years old (57%), suffered mainly major OP fracture (68%), and had multiple comorbidities (≥ 2, 89.2%). While two-thirds had OP diagnosis and 61.1% received OP medication anytime in the past, 56.8% were not currently receiving OP medication. Diagnosis and treatment rates were lower among men (43% and 38% vs. 70% and 65%, respectively).

Conclusion

Prevalence of FF was high, especially in women. One-third of subjects lacked OP diagnosis and ≥ 50% were not receiving OP treatment; diagnosis and treatment gaps were larger among men. This reinforces the need to improve the management of FF in the elderly population. However, as PC centers participating in this study had high OP experience that have the potential to do better in terms of diagnosis and treatment, caution in the generalization of these data should be taken.

中文翻译：

西班牙初级保健中脆性骨折的患病率和治疗：PREFRAOS 研究

概括

在西班牙初级保健 (PC) 中，≥ 70 岁受试者的脆性骨折 (FF) 患病率很高，尤其是女性。三分之一的 FF 受试者缺乏骨质疏松症 (OP) 诊断，并且 >50% 目前未接受 OP 药物治疗。需要改进这一人群的 FF 管理。

目的

在西班牙 PC，FF 的患病率很高，尤其是在女性中。三分之一的 FF 受试者缺乏 OP 诊断，超过一半目前未接受 OP 药物治疗。几项研究报告了患有 FF 的老年受试者 PC 中 OP 的诊断不足/治疗不足。迄今为止，西班牙不存在此类数据。目的是估计 FF 在老年人口（≥ 70 岁）中的患病率，并描述西班牙 PC 中心 FF 受试者的特征、危险因素、合并症和 OP 诊断和治疗率。

方法

这是一项在西班牙进行的观察性回顾性研究，由两个阶段组成。A 阶段包括 2018 年 11 月至 2020 年 3 月该中心病历中列出的所有年龄≥70 岁的受试者。B 阶段包括患有 FF 且因任何原因事先在中心咨询过的受试者。只有之前参加过另一项研究的受试者才会被排除在外。主要结果是 FF 的患病率（A 阶段）和至少有一个 FF 的受试者的特征（B 阶段）。

结果

在出于任何原因就诊医疗中心的受试者中，FF 的总体患病率为 17.7%（24.1% 女性对 8.0% 男性）（来自 14 个西班牙地区的 30 个 PC 中心）。椎骨 (5.1%) 是最常见的骨折。在 B 期的 665 名受试者中，大多数 (87%) 是女性和 ≥ 80 岁 (57%)，主要遭受主要 OP 骨折 (68%)，并有多种合并症 (≥ 2, 89.2%)。虽然三分之二的人有 OP 诊断并且 61.1% 的人在过去的任何时候接受过 OP 药物治疗，但 56.8% 的人目前没有接受 OP 药物治疗。男性的诊断率和治疗率较低（分别为 43% 和 38% 对 70% 和 65%）。