Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom

Abstract

This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. Introduction Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an antiosteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. Methods This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. Results A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. Conclusion Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

The impact of fracture liaison services on subsequent fractures and mortality: a systematic literature review and meta-analysis

“…Despite the availability of various effective pharmacologic interventions and well-established guidelines for fracture prevention, the majority of patients sustaining a fragility fracture do not receive anti-osteoporosis drugs (AOD) [ 1 ]. This treatment gap is more pronounced in men than in women, and worsened in recent years [ 7 ]. The magnitude of the treatment gap is reported to be highly variable throughout Europe, ranging between 25 and 95% [ 8 ].…”

The treatment gap after major osteoporotic fractures in Denmark 2005-2014: a combined analysis including both prescription-based and hospital-administered anti-osteoporosis medications

“…The post-fracture treatment gap in Denmark was evaluated recently—conjointly with the United Kingdom and Catalonia—using comparable data sources linked to the IFRISK study, demonstrating large and persistent treatment gaps in Denmark [ 27 ]. This current paper was conceptualized to evaluate if inclusion of hospital-administered AOM would reduce this treatment gap.…”

“…Reassuringly, this current paper demonstrates smaller—yet still very large—treatment gaps in Denmark in patients with a major osteoporotic fracture as compared to any osteoporotic fracture as was reported previously. For hip, vertebral, and forearm fractures (MOF and humerus fractures were not independently evaluated in the former paper) the treatment gaps are generally smaller in this current analysis, probably owing to the differences in study design and the inclusion of hospital-administered AOM [ 27 ].…”

“…This post-fracture treatment gap seems to be more pronounced in men [ 24 – 26 ]. We have recently published a study of the changing treatment gap from 2005 to 2015 across the United Kingdom, Catalonia, and Denmark, which confirmed the continuing existence of this treatment gap—with a persistent treatment gap of approximately 88–90% in Denmark—among patients with any first incident osteoporotic fracture [ 27 ]. We have only identified one treatment gap study attempting to identify the use of hospital-administered AOM [ 28 ], and only few studies reporting the use of AOM which in Denmark would be administered at a hospital—zoledronic acid and potentially denosumab—in their treatment gap assessment [ 19 , 29 ].…”

Efficacy and efficiency of fracture liaison services to reduce the risk of recurrent osteoporotic fractures

“…Healthcare systems are now beginning to recognise the benefits of secondary fracture prevention [ 4 ] and prioritise secondary fracture prevention above primary prevention and fall prevention, where the return on investment of healthcare resources may be less. Despite effective treatments to reduce fracture risk, less than 50% of patients receive effective secondary fracture prevention after a fragility fracture [ 5 , 6 ]. To address this care gap, several initiatives have been published to improve clinical services by implementing fracture liaison services (FLSs) [ 7 – 14 ].…”