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
Skjødt, M. K. (Odense University Hospital (Dinamarca))
Khalid, Sara (Oxford University Hospitals. Nuffield Orthopaedic Centre)
Ernst, Martin (University of Southern Denmark. Department of Public Health, Clinical Pharmacology and Pharmacy)
Rubin, K. H. (Odense University Hospital (Dinamarca))
Martínez-Laguna, Daniel (Universitat Autònoma de Barcelona. Departament de Medicina)
Delmestri, Antonella (Oxford University Hospitals. Nuffield Orthopaedic Centre)
Javaid, M. K. (Oxford University Hospitals. Nuffield Orthopaedic Centre)
Cooper, Cyrus (University Hospital Southampton NHS Foundation Trust (Regne Unit))
Libanati, Cesar (UCB Pharma)
Toth, E. (UCB Pharma)
Abrahamsen, Bo (Oxford University Hospitals. Nuffield Orthopaedic Centre)
Prieto-Alhambra, Daniel (Oxford University Hospitals. Nuffield Orthopaedic Centre)

Fecha:	2020
Resumen:	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. 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. 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. 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. 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 online version of this article (10. 1007/s00198-020-05358-4) contains supplementary material, which is available to authorized users.
Nota:	Altres ajuts: UCB funded this study. All analyses were conducted independently by the academic researchers involved. MKJ is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Fracture prevention ; Health Services Research
Publicado en:	Osteoporosis International, Vol. 31 (march 2020) , p. 1535-1544, ISSN 1433-2965

DOI: 10.1007/s00198-020-05358-4
PMID: 32185437

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