Osteoporosis treatment gap in a prospective cohort of volunteer women

Iconaru, Laura; Smeys, Celeste; Baleanu, Felicia; Kinnard, V.; Moreau, Michel; Cappelle, Sylvie; Surquin, Murielle; Rubinstein, Michel; Rozenberg, Serge; Paesmans, Marianne; Karmali, Rafik; Bergmann, Pierre; Body, Jean‐Jacques

doi:10.1007/s00198-020-05339-7

Cited by 13 publications

(10 citation statements)

References 22 publications

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“…While those who experience a nontraumatic fracture are considered to be at very high risk of fracture, most patients presenting with incident nontraumatic fractures are neither assessed nor treated for osteoporosis to reduce their risk of subsequent fractures, despite the availability of effective treatments [13]. Recent reports indicate that only about 20% of patients with a fracture receive treatment to reduce the risk of subsequent fractures [14,15]. Effective management of these fractures requires appropriate management of the underlying osteoporosis along with acute treatment for fractures [13].…”

Section: Introductionmentioning

confidence: 99%

Medical management patterns in a US commercial claims database following a nontraumatic fracture in postmenopausal women

Wang

Oates

et al. 2022

Arch Osteoporos

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Summary Among women ≥ 50 years with fracture, 76% had not received osteoporosis diagnosis or treatment at 6 months and only 14% underwent a DXA scan. Nearly half of all and 90% of hip fracture patients required surgery. Fractures cause substantial clinical burden and are not linked to osteoporosis diagnosis or treatment. Purpose Osteoporosis (OP) and OP-related fractures are a major public health concern, associated with significant economic burden. This study describes management patterns following a nontraumatic fracture for commercially insured patients. Methods This retrospective cohort study identified women aged ≥ 50 years having their first nontraumatic index fracture (IF) between January 1, 2015 and June 30, 2019, from IQVIA’s PharMetrics® Plus claims database. Medical management patterns at month 6 and medication use patterns at months 6, 12, and 24 following the IF were described. Results Among 48,939 women (mean (SD) age: 62.7 (9.5) years), the most common fracture types were vertebral (30.6%), radius/ulna (24.9%), and hip (HF; 12.1%). By month 6, 76% of patients had not received an OP diagnosis or treatment, 13.6% underwent a DXA scan, and 11.2% received any OP treatment. Surgery was required in 43.1% of all patients and 90.0% of HF patients on or within 6 months of the fracture date. Among HF patients, 41.4% were admitted to a skilled nursing facility, 96.7% were hospitalized an average of 5.5 days, and 38.1% required durable medical equipment use. The 30-day all-cause readmission rate was 14.3% among those hospitalized for the IF. Overall, 7.4%, 9.9%, and 13.2% had a subsequent fracture at months 6, 12, and 24, respectively. Conclusion Our findings provide an overview of post-fracture management patterns using real-world data. OP was remarkably underdiagnosed and undertreated following the initial fracture. Nontraumatic fracture, particularly HF, resulted in substantial ongoing clinical burden.

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Section: Introductionmentioning

confidence: 99%

Medical management patterns in a US commercial claims database following a nontraumatic fracture in postmenopausal women

Wang

Oates

et al. 2022

Arch Osteoporos

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“…Pharmacological treatments reduce fracture incidence by 30% to 60% ( 1 , 2 ) and postfracture mortality rate by 10% ( 3 , 4 ). However, despite the efficacy of available drugs, only 20% to 30% of women at high risk of fracture are treated ( 5 , 6 ).…”

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confidence: 99%

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

Baleanu

Moreau

Charles

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Individualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, though their external validation has shown significant differences in their risk prediction ability. Objective and Methods Using data from the FRISBEE study, a cohort of 3560 post-menopausal women aged 60-85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Three models of competing risk analysis were developed to predict major osteoporotic fractures (MOFs), all fractures and central fractures (femoral neck, shoulder, clinical spine, pelvis, ribs, scapula, clavicle, sternum). Results Age, a history of fracture and hip or spine BMD were predictors common to the three models. Excessive alcohol intake, and the presence of comorbidities were specific additional CRFs for MOFs, a history of fall for all fractures and rheumatoid arthritis for central fractures. Our models predicted the fracture probability at 5-years with an acceptable accuracy (Brier scores ≤ 0.1) and had a good discrimination power (area under the receiver operating curve of 0.73 for MOFs and 0.72 for central fractures) when internally validated by bootstrap. Three simple nomograms, integrating significant CRFs and the mortality risk were constructed for different fracture sites. In conclusion, we derived three models predicting fractures with an acceptable accuracy, particularly for MOFs and central fractures. The models are based on a limited number of CRFs and we constructed nomograms for use in clinical practice.

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“…Unfortunately, despite the availability of effective treatments, the prescription and adherence to an osteoporosis therapy after a sentinel fracture is low (around 20% of eligible patients) and declining ( Iconaru et al, 2020 ). The estimated probability of osteoporosis medication used in the year after hip fracture decreased significantly from 40% to 21% over a 10-year study period ( Kanis et al, 2017 ; Solomon et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

“…The estimated probability of osteoporosis medication used in the year after hip fracture decreased significantly from 40% to 21% over a 10-year study period ( Kanis et al, 2017 ; Solomon et al, 2014 ). This highlights the urgent need of additional education for the medical profession and patients regarding the risk-benefit balance of treatment ( Iconaru et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Which treatment to prevent an imminent fracture?

et al. 2021

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Purpose To provide a summarized state of the art of the relative efficacy and rapidity of action of pharmacological treatments to prevent imminent osteoporotic fractures. Methods We reviewed metanalyses (MA) and network metaanalyses (NMA) published during the last 10 years concerning the pharmacological treatment of osteoporosis. We compared the anti-fracture efficacy and the rapidity of action of various agents versus placebo and versus risedronate. Results All bisphosphonates decrease the incidence of vertebral fractures compared with placebo. Ibandronate is the only one without demonstrated efficacy against non-vertebral and hip fractures. Zoledronate, denosumab and anabolic therapy are associated with a higher fracture risk reduction than oral bisphosphonates. Compared with risedronate, which significantly reduces the rate of hip fractures, zoledronate, denosumab, teriparatide, abaloparatide and romosozumab are more efficient for vertebral fractures but not for non-vertebral or hip fractures reduction. No studies have compared bone anabolic treatments with zoledronate or denosumab. Oral bisphosphonates significantly reduce fracture risk only after more than one year of therapy. A faster reduction of fracture risk is observed with zoledronate and denosumab, or with anabolic agents. For denosumab and anabolic agents, a sequential treatment is required to keep gains after treatment withdrawal. Conclusions In patients at high risk of imminent fracture, starting therapy with potent antiresorptive agents or with an anabolic agent seems most appropriate to promptly reduce the fracture risk. Available NMA/MA suggest that, compared to zoledronate and denosumab, anabolic agents have a higher efficacy for vertebral fractures but head-to-head studies are lacking.

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Osteoporosis treatment gap in a prospective cohort of volunteer women

Cited by 13 publications

References 22 publications

Medical management patterns in a US commercial claims database following a nontraumatic fracture in postmenopausal women

Medical management patterns in a US commercial claims database following a nontraumatic fracture in postmenopausal women

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

Which treatment to prevent an imminent fracture?

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