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. 2020 Jul;31(7):1377-1382.
doi: 10.1007/s00198-020-05339-7. Epub 2020 Mar 3.

Osteoporosis treatment gap in a prospective cohort of volunteer women

L Iconaru  1 , C Smeys  2 , F Baleanu  3 , V Kinnard  4 , M Moreau  5 , S Cappelle  2 , M Surquin  2 , M Rubinstein  6 , S Rozenberg  7 , M Paesmans  5 , R Karmali  3 , P Bergmann  8 , J J Body  3
Affiliations

Osteoporosis treatment gap in a prospective cohort of volunteer women

L Iconaru et al. Osteoporos Int. 2020 Jul.

Abstract

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.

Keywords: Elderly; Fracture; Osteoporosis; Risk factors; Treatment gap.

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