2018 update of French recommendations on the management of postmenopausal osteoporosis

Briot, Karine; Roux, Christian; Thomas, Thierry; Blain, Hubert; Buchon, Daniel; Chapurlat, Roland; Debiais, Françoise; Féron, J.-M.; Gauvain, J. B.; Guggenbuhl, Pascal; Legrand, E; Lehr-Drylewicz, Anne Marie; Lespessailles, Éric; Tremollieres, F.; Weryha, G.; Cortet, Bernard

doi:10.1016/j.jbspin.2018.02.009

Cited by 114 publications

(74 citation statements)

References 111 publications

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“…Percentages based on number of patients enrolled who are at increased risk of fragility fracture using the base definition Our data demonstrate that oral bisphosphonates are still the most widely used agents, comprising 58% of first-line OP medication (58.3%) compared with 28% receiving denosumab, and only 8% accessing parenteral bisphosphonate therapy. The vast majority of patients on second-line therapy received non-oral treatment (denosumab, 76%; parenteral BP, 10%), a pattern that is consistent with recommendations in key European guidelines [9,[14][15][16].…”

Section: Discussionsupporting

confidence: 54%

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

McCloskey

Rathi²,

Heijmans³

et al. 2020

Osteoporos Int

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This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor. Introduction Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe. Methods This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool [FRAX] thresholds, T-score ≤ − 2.5). Results Median 10-year probability of fracture (without bone mineral density [BMD]) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ − 2.5 (only 944 received a dualenergy x-ray absorptiometry [DXA] scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%. Conclusions There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.

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Section: Discussionsupporting

confidence: 54%

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

McCloskey

Rathi²,

Heijmans³

et al. 2020

Osteoporos Int

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“…Osteoporosis is preventable and treatable using the various pharmacological therapies available and this management reduces fracture rates [7,8]. Dual-Energy X-ray Absorptiometry (DEXA) scan is the cornerstone of osteoporosis screening, while the Fracture Risk Assessment Tool (FRAX) score adds valuable further information when evaluating fracture risk [9,10]. Despite the clear links between osteoporosis and fracture, screening rates are low in primary care with only 21.1, 26.5 and 12.8% of women aged 50-64, 65-79 and > 80 years, respectively, being screened in a large US study [5], while only 10.8% of women > 65 years underwent osteoporosis screening in a US primary care setting [11].…”

Section: Introductionmentioning

confidence: 99%

High detection rate of osteoporosis with screening of a general hospitalized population: a 6-year study in 6406 patients in a university hospital setting

Malaise

Detroz

Leroy

et al. 2020

BMC Musculoskelet Disord

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Background: Osteoporosis is a highly prevalent disease identified by Dual Energy X-ray Absorptiometry (DEXA) that can be performed in an ambulatory (out-patient) or hospitalized population. We evaluated the use of baseline inhospital DEXA screening to identify osteoporosis in ambulatory care and hospitalized patients; we also assessed specific risk factors for osteoporosis among these populations. Methods: We included a baseline initial DEXA from 6406 consecutive patients at our tertiary referral University Hospital. Results: Osteoporosis was diagnosed in 22.3% of the study population. In univariate analysis, osteoporosis risk factors were age, fracture history and low BMI (for all 3 sites), but also corticotherapy (lumbar spine and femoral neck) and male (lumbar spine). In multivariate analysis, age, fracture history, low BMI, and male increased osteoporosis risk. In-hospital screening yielded a higher percentage of osteoporosis positive scans than ambulatory care screening (31.8% vs 18.5%, p < 0.001). In-hospital screening targeted an older and more predominantly male population with a higher fracture history. Z-scores revealed that this difference was not only due to an older age of the population and mainly concerned cortical bone. Conclusions: In-hospital osteoporosis screening revealed more osteoporosis than screening in ambulatory practice and could be an additional tool to improve the identification and management of osteoporosis. In addition to typical risk factors, we identified male gender as associated with osteoporosis detection in our cohort.

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“…Osteoporosis has been identified as a major public health concern due to the serious consequences of osteoporotic fractures and its increasing prevalence with population ageing [2][3][4] . The main objective of anti-osteoporotic treatment is to reduce the risk of fracture 5,6 . Bisphosphonates are antiresorptive medications which have demonstrated their efficacy to prevent osteoporotic fracture [7][8][9][10] .…”

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confidence: 99%

“…Bisphosphonates are antiresorptive medications which have demonstrated their efficacy to prevent osteoporotic fracture [7][8][9][10] . Oral bisphosphonates are recommended among the first-line treatments for osteoporosis 5,6 . Several studies have indicated that non-persistence and poor implementation were associated with increased risk of fracture 11,12 and reduced drug effectiveness, which consequently results in significant higher clinical burden and healthcare costs 13 .…”

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confidence: 99%

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Adherence with brand versus generic bisphosphonates among osteoporosis patients: a new-user cohort study in the French National Healthcare Insurance database

Viprey

Xue

Rousseau

et al. 2020

Sci Rep

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Several studies documented declines in treatment adherence with generic forms of oral bisphosphonates in osteoporosis compared to branded forms, while others did not support this relation. Our aim was to compare medication adherence with brand versus generic forms of oral bisphosphonates. A new-user cohort study was conducted using routinely collected administrative and healthcare data linked at the individual level extracted from a nationwide representative sample of the French National Healthcare Insurance database. We included all patients aged 50 and older, new users of oral bisphosphonates for primary osteoporosis between 01/01/2009 and 31/12/2015. Two components of adherence were measured: implementation (continuous multiple-interval measure of medication availability version 7; CMA7) and persistence (time to discontinuation). The sample was composed of 1,834 in the "brand bisphosphonate" group and 1,495 patients in the "generic bisphosphonate" group. Initiating oral bisphosphonate treatment with brand was associated with a higher risk of discontinuation within 12 months (Hazard Ratio = 1.08; 95%CI = [1.02;1.14]). The risk of good implementation (CMA7 ≥ 0.90) was significantly lower in "brand bisphosphonate" group (Risk Ratio = 0.90; 95%CI = [0.85; 0.95]). We did not find any evidence to support the hypothesis of a lower adherence to generic bisphosphonates. In fact, prescribing of generic bisphosphonates led to a higher persistence rate and to better implementation at 1 year.

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2018 update of French recommendations on the management of postmenopausal osteoporosis

Cited by 114 publications

References 111 publications

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study

High detection rate of osteoporosis with screening of a general hospitalized population: a 6-year study in 6406 patients in a university hospital setting

Adherence with brand versus generic bisphosphonates among osteoporosis patients: a new-user cohort study in the French National Healthcare Insurance database

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