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Endocrine. 2018 Dec 4. doi: 10.1007/s12020-018-1824-9. [Epub ahead of print]

Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk.

Author information

1
CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy. luca.degliesposti@clicon.it.
2
CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy.
3
Department of Medicine, Clinica Medica 1, University of Padova and Regional Center for Osteoporosis, Padova, Italy.
4
UOC HTA, Azienda Zero-Regione Veneto, Verona, Italy.
5
Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.

Abstract

PURPOSE:

To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality.

METHODS:

This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality.

RESULTS:

A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (N = 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420-0.735, p < 0.001) and 64.4% lower in those receiving calcium/vitamin D supplementation compared to osteoporosis treatment only (HR = 0.356, 95% CI = 0.237-0.533, p < 0.001). The risk of re-fracture was 77.2% lower in treated patients who were adherent to medication (HR = 0.228, 95% CI = 0.139-0.376, p < 0.001). Treated patients had 64% lower mortality risk over the follow-up compared to untreated ones (HR = 0.360, 95% CI = 0.310-0.418, p < 0.001).

CONCLUSIONS:

A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.

KEYWORDS:

Calcium/vitamin D; Clinical setting; Osteoporosis; Re-fracture risk; Treatment patterns

PMID:
30515678
DOI:
10.1007/s12020-018-1824-9

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