Long-term persistence of treatment after hip fracture in a fracture liaison service; recommending treatment during admission is more efficient

Abstract

Background Long-term adherence to antiosteoporosis medication (AOM) in the setting of a fracture liaison service (FLS) are not well known. Methods Patients ≥50 with hip fracture seen in an FLS and recommended for treatment to prevent new fractures were analyzed. Baseline data included demographics, identification mode, previous treatment and FRAX® items. Patient records were reviewed 3-8 years later, and these data were collected: 1) survival; 2) major refracture; 3) initiation of treatment, proportion of days covered (PDC) and persistence with AOM. Results 372 patients (mean age, 79 years; 76% women) were included. Mean follow-up was 47 months, 52 patients (14%) had a refracture (22 hip) and 129 (34.5%) died. AOM was started in 283 patients (76.0%). Factors associated with initiation of AOM were previous use of bisphosphonate (OR9.94;95%CI:1.29-76.32) and a lower T-score lumbar (OR 0.80;95%CI:0.65-0.99). Persistence decreased to 72.6%, 60% and 47% at 12, 36 and 60 months. A PDC>80% was confirmed in 208 patients (55.7%) and associated with previous use of bisphosphonate (OR3.38;95%CI:1.34-8.53), treatment with denosumab (OR2.69;95%CI:1.37-5.27), and inpatient identification (OR2.26; 95%CI:1.18-4.34). Conclusions Long-term persistence with AOM was optimal in patients with hip fracture seen at an FLS. A PDC>80% was associated with inpatient identification and prescription of denosumab.