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Osteoporosis treatment gap in a prospective cohort of volunteer women

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Abstract

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.

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References

  1. Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. https://doi.org/10.1007/s11657-013-0136-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Roh YH, Lee ES, Ahn J, Kim HS, Gong HS, Baek KH, Chung HY (2019) Factors affecting willingness to get assessed and treated for osteoporosis. Osteoporos Int 30(7):1395–1401. https://doi.org/10.1007/s00198-019-04952-5

    Article  CAS  PubMed  Google Scholar 

  3. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15(2):108–112. https://doi.org/10.1007/s00198-003-1516-y

    Article  PubMed  Google Scholar 

  4. Keshishian A, Boytsov N, Burge R, Krohn K, Lombard L, Zhang X, Xie L, Baser O (2017) Examining the treatment gap and risk of subsequent fractures among females with a fragility fracture in the US Medicare population. Osteoporos Int 28(8):2485–2494. https://doi.org/10.1007/s00198-017-4072-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, KrohnKD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937. https://doi.org/10.1002/jbmr.2202

    Article  PubMed  Google Scholar 

  6. Spångéus A, Åkesson K, Ljunggren Ö, Banefelt J, Karlsson L, Ortsäter G, Libanati C, Toth E, Ström O (2017) The treatment gap after fracture in osteoporosis patients in Sweden. Ann Rheum Dis 76(2):72. https://doi.org/10.1136/annrheumdis-2017-eular.3397

    Article  Google Scholar 

  7. Sattari M, Cauley JA, Garvan C, Johnson KC, LaMonte MJ, Li W, Limacher M, Manini T, Sarto GE, Sullivan SD, Wactawski-Wende J, Beyth RJ (2017) Osteoporosis in the women’s health initiative: another treatment gap? Am J Med 130(8):937–948. https://doi.org/10.1016/j.amjmed.2017.02.042

  8. Byszewski A, Lemay G, Molnar F, Azad N, McMartin SE (2011) Closing the osteoporosis care gap in hip fracture patients: an opportunity to decrease recurrent fractures and hospital admissions. J Osteoporos:404969. https://doi.org/10.4061/2011/404969

  9. Chen W, Simpson JM, March LM, Blyth FM, Bliuc D, Tran T, Nguyen TV, Eisman JA, Center JR (2018) Co-morbidities only account for a small proportion of excess mortality after fracture: a record linkage study of individual fracture types. J Bone Miner Res 33(5):795–802. https://doi.org/10.1002/jbmr.3374

    Article  PubMed  Google Scholar 

  10. Eisman J, Clapham S, Kehoe L (2004) Australian Bone Care Study. Osteoporosis prevalence and levels of treatment in primary care: the Australian Bone Care study. J Bone Miner Res 19(12):1969–1975. https://doi.org/10.1359/JBMR.040905

    Article  PubMed  Google Scholar 

  11. Teede HJ, Jayasuriya IA, Gilfillan CP (2007) Fracture prevention strategies in patients presenting to Australian hospitals with minimal trauma fractures: a major treatment gap. Intern Med J 37(10):674–679. https://doi.org/10.1111/j.1445-5994.2007.01503

    Article  CAS  PubMed  Google Scholar 

  12. Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E (2017) Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res 32(3):424–430. https://doi.org/10.1002/jbmr.3074

    Article  PubMed  Google Scholar 

  13. Kanis JA, Svedbom A, Harvey N, McCloskey EV (2014) The osteoporosis treatment gap. J Bone Miner Res 29(9):1926–1928. https://doi.org/10.1002/jbmr.2301

    Article  PubMed  Google Scholar 

  14. Siu A, Allore H, Brown D, Charles ST, Lohman M (2019) National Institutes of Health pathways to prevention workshop: research gaps for long-term drug therapies for osteoporotic fracture prevention. Ann Intern Med 171(1):51–57. https://doi.org/10.7326/M19-0961

    Article  PubMed  Google Scholar 

  15. Brask-Lindemann D, Cadarette SM, Eskildsen P, Abrahamsen B (2011) Osteoporosis pharmacotherapy following bone densitometry: importance of patient beliefs and understanding of DXA results. Osteoporos Int 22(5):1493–1501. https://doi.org/10.1007/s00198-010-1365-4

    Article  CAS  PubMed  Google Scholar 

  16. Leder BZ, Clarke BL, Shane E, Khosla S, Kiel DP (2019) A lot of progress, with more to be done: a response to NIH pathways to prevention report “research gaps for long-term drug therapies for osteoporotic fracture prevention”. J Bone Miner Res 9(34):1549–1551. https://doi.org/10.1002/jbmr.3823

    Article  Google Scholar 

  17. Cappelle SI, Ramon I, Dekelver C, Rozenberg S, Baleanu F, Karmali R, Rubinstein M, Tondeur M, Moreau M, Paesmans M, Bergmann P, Body JJ (2017) Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: the FRISBEE study and comparison with other major cohort studies. Maturitas 106:1–7. https://doi.org/10.1016/j.maturitas.2017.08.010

    Article  CAS  PubMed  Google Scholar 

  18. Iconaru L, Moreau M, Kinnard V, Baleanu F, Paesmans M, Karmali R, Body JJ, Bergmann P (2019) Does the prediction accuracy of osteoporotic fractures by BMD and clinical risk factors vary with fracture site? JBMR Plus 3(12):1–7. https://doi.org/10.1002/jbm4.10238

    Article  Google Scholar 

  19. Pepe J, Cipriani C, Cecchetti V, Ferrara C, Della Grotta G, Danese V, Colangelo L, Minisola S (2019) Patients’ reasons for adhering to long-term alendronate therapy. Osteoporos Int 30(8):1627–1634. https://doi.org/10.1007/s00198-019-05010-w

    Article  CAS  PubMed  Google Scholar 

  20. Desai RJ, Mahesri M, Abdia Y, Barberio J, Tong A, Zhang D, Mavros P (2018) Association of osteoporosis medication use after hip fracture with prevention of subsequent nonvertebral fractures an instrumental variable analysis. JAMA Netw Open 1(3):e180826. https://doi.org/10.1001/jamanetworkopen.2018.0826

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lorentzon M, Nilsson AG, Johansson H, Kanis JA, Mellström D, Sundh D (2019) Extensive undertreatment of osteoporosis in older Swedish women. Osteoporos Int 30:1297–1305. https://doi.org/10.1007/s00198-019-04872-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The FRISBEE study is supported by IRIS-Recherche and CHU Brugmann.

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Authors and Affiliations

  1. Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    L. Iconaru, F. Baleanu, R. Karmali & J. J. Body

  2. Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    C. Smeys, S. Cappelle & M. Surquin

  3. Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    V. Kinnard

  4. Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium

    M. Moreau & M. Paesmans

  5. Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

    M. Rubinstein

  6. Department of Gynecology, CHU St Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium

    S. Rozenberg

  7. Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    P. Bergmann

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  1. L. Iconaru
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  2. C. Smeys
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  3. F. Baleanu
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Correspondence to L. Iconaru.

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Iconaru, L., Smeys, C., Baleanu, F. et al. Osteoporosis treatment gap in a prospective cohort of volunteer women. Osteoporos Int 31, 1377–1382 (2020). https://doi.org/10.1007/s00198-020-05339-7

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