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. 2020 Aug;31(8):1535-1544.
doi: 10.1007/s00198-020-05358-4. Epub 2020 Mar 17.

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

M K Skjødt  1   2   3 , S Khalid  4 , M Ernst  3   5 , K H Rubin  3 , D Martinez-Laguna  6   7   8 , A Delmestri  4 , M K Javaid  4 , C Cooper  4   9 , C Libanati  10 , E Toth  10 , B Abrahamsen  11   12   13 , D Prieto-Alhambra  4
Affiliations

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

M K Skjødt et al. Osteoporos Int. 2020 Aug.

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 anti-osteoporotic 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.

Keywords: Fracture prevention; Health Services Research.

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Conflict of interest statement

MKS has institutional research contract with UCB and educational grant from UCB. SK has nothing to disclose. ME has institutional research contract with UCB. KHR has nothing to disclose. DML received personal fees from Amgen, Eli Lilly, Novartis, Ferrer, and Rubió. AD reports grants from UCB during the conduct of the study. MKJ received honoraria, unrestricted research grants, and travel and/or subsistence expenses from Amgen and UCB. CC received personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. CL and ET are employees of UCB Pharma. BA has institutional research contracts with Novartis and UCB with funds paid to the institution and received speaker fees from Amgen and personal consultancy fees from UCB and Kyowa-Kirin UK. DPA received institutional research grants from UCB and Amgen, grant from Les Laboratoires Servier, educational grants from Johnson & Johnson, and speaker and consultancy fees paid to his department by Amgen and UCB. Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organized by DPA’s department and open for external participants.

Figures

Fig. 1
Fig. 1
The treatment gap for all fractures across the United Kingdom, Catalonia and Denmark. The treatment gap is given as the proportion of patients not treated with AOM within 1 year following their index fracture
Fig. 2
Fig. 2
The treatment gap in the United Kingdom stratified according to fracture location (all, hip, spine, non hip non spine, and wrist fractures, respectively) and time period
Fig. 3
Fig. 3
The treatment gap in Catalonia stratified according to fracture location (all, hip, spine, non hip non spine, and wrist fractures, respectively) and time period
Fig. 4
Fig. 4
The treatment gap in Denmark stratified according to fracture location (all, hip, spine, non hip non spine, and wrist fractures, respectively) and time period
Fig. 5
Fig. 5
The treatment gap in the United Kingdom (a), Catalonia (b), and Denmark (c), stratified according to time period, gender, and fracture location (all, hip, and spine, respectively)
See this image and copyright information in PMC

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