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Observational Study
. 2025 Nov;36(11):2245-2255.
doi: 10.1007/s00198-025-07565-3. Epub 2025 Sep 12.

Adequacy of pharmacological prescription in patients at very high risk of fracture within the FLS in Spain: analysis of the REFRA FLS-SEIOMM Registry

M J Montoya-Garcia #  1 , C Carbonell-Abella #  2 , M Giner García  3 , B Hernández-Cruz  4 , C Gómez-Vaquero  5 , A Naranjo  6 , R Izquierdo Aviñó  7 , D Mifsut Miedes  8 , A P Mozo Muriel  9 , J Mora-Fernández  10 , S Castro Oreiro  11 , D Ovejero Crespo  12 , M Jordà Llona  13 , C Alvarado Escobar  14 , M M Femenías Sureda  15 , L Cuadra-Llopart  16 , M Mesa Ramos  17 , S Santana Zorrilla  18 , D Martínez-Laguna  19 , G Martínez Díaz-Guerra  20 , J M Cancio-Trujillo  21 ; GRUPO REFRA_FLS
Collaborators, Affiliations
Observational Study

Adequacy of pharmacological prescription in patients at very high risk of fracture within the FLS in Spain: analysis of the REFRA FLS-SEIOMM Registry

M J Montoya-Garcia et al. Osteoporos Int. 2025 Nov.

Abstract

This study classifies osteoporotic patients treated in 16 FLS in Spain, evaluating therapeutic alignment with SEIOMM recommendations and imminent risk fracture. Findings indicate that 26.8% of patients are at very high-risk fracture, highlighting the need for better prescription practices for osteoanabolics. Fall prevention is pivotal in reducing new fractures.

Objective: To classify patients treated in 16 Fracture Liaison Services (FLS) in Spain according to high-risk fracture (HRF) and very high-risk fracture (VHRF) and evaluate the alignment of their pharmacological treatment with the Spanish Society for Bone and Mineral Metabolism Research (SEIOMM) guidelines. Additionally, we assessed the incidence of new fractures over a one-year follow-up period and analyzed associated risk factors.

Methods: This retrospective, multicenter, population-based observational cohort study included patients aged ≥ 50 years with at least one fragility fracture in the preceding year. Data were collected from medical records from January 2015 to April 2024, capturing sociodemographic information, fracture characteristics, comorbidities, pharmacological treatments, and fall risk.

Results: Of 7161 patients, 1413 had one year of follow-up and sufficient baseline data for classification as either VHRF or HRF. Among these, 1034 (73.2%) were classified as HRF and 379 (26.8%) as VHRF. The median age was significantly higher in the VHRF group (76 vs. 72 years in HRF; p < 0.001). Pharmacological treatment was initiated in 86.5% of patients. Alendronate was predominantly prescribed for the HRF group, while parenteral treatments (zoledronate, denosumab) were more common in the VHRF group. During the first year, 84 patients (5.9%) experienced a new fracture, with 2 or more falls significantly associated with these subsequent fractures.

Conclusion: 26.8% of patients were classified as VHRF. Treatment partially aligned with SEIOMM guidelines, though improved adherence to sequential osteoanabolic treatment is essential in VHRF patients. Fall prevention remains critical to reducing fracture recurrence.

Keywords: Adherence; Fracture Liaison Services; Fragility fractures; High-risk fracture; Osteoporosis; Very high-risk fracture.

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Conflict of interest statement

Declarations. Ethics approval: The study protocol was approved by the Clinical Research Ethics Committee of Hospital del Mar (Barcelona) (2018/7852/I). Consent to participate: Informed consent was obtained from all study participants. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patients participating in the study. All patients were classified as high-risk fracture (HRF) or very high-risk fracture (VHRF) and had bone mineral density and lateral spine radiographs
Fig. 2
Fig. 2
Osteoporotic treatment according to high risk fracture (HRF) or very high risk fracture (VHRF) patient group. *p < 0.05 HRF vs VHRF
See this image and copyright information in PMC

References

    1. Cooper C, Cole ZA, Holroyd CR et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–88. https://pubmed.ncbi.nlm.nih.gov/21461721/ - PMC - PubMed
    1. Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105. https://pubmed.ncbi.nlm.nih.gov/20125177/ - PubMed
    1. Barnsley J, Buckland G, Chan PE et al (2021) Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res 133(4):759–73. https://pubmed.ncbi.nlm.nih.gov/33742387/ - PMC - PubMed
    1. Saito T, Sterbenz JM, Malay S, Zhong L, MacEachern MP, Chung KC (2017) Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int;28(12):3289–300. https://pubmed.ncbi.nlm.nih.gov/28770272/ - PubMed
    1. Borgström F, Karlsson L, Ortsäter G et al (2020) Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos;15(1). https://pubmed.ncbi.nlm.nih.gov/32306163/ - PMC - PubMed

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