Background Althoughmanagement of osteoporosis (OP) is cost-effective in high-risk patients, less than 20% of patients with fragility fracture receive antiresorptive drugs.
Objectives The main objective was to evaluate a program for secondary prevention of OP fracturesbased in the coordination between physicians and rheumatology nurse
Methods Patients >50 years with fragility fracture were enrolled in a prospective observational study. The program consisted of: 1) training of primary care physicians, 2) recruitment of patients from emergency unit registration, 3) baseline visit: questionnaire by the nurse (including FRAX variables) and bone densitometry (DXA); 4) patient education by the nurse about healthy habits, diet and prevention of falls; 5) clinical report, including recommendations about treatment, and referral to primary care of all patients, except those with multiple fractures or requiring special therapy, which were derived to the rheumatology service. A treatment algorithm based on the NOF 2010 guidelines was agreed between rheumatologists and primary care; and 6) follow-up through a phone survey and checking the prescriptions in electronic records. Asa reference group, we performed an analysis of treatments initiated in patients with fracture before the study. The outcome variables were: 1) the percentage of patients who initiated antiresorptive treatment at 3 months, and 2) percentage of patients who continued treatment at 1-3years.
Results The results of the first 8 months of the program are shown. In the retrospective analysis, a total of 23 (13%) out of 167 patients were prescribed antiresorptive drugs after a fracture. In the prospective study, 397 patients with inclusion criteria were contacted and invited to participate of which 156 (39%) did not agree to participate. Compared with those who agreed to participate, the patiens who refused were older (73 vs 70 years, P <0.01) and had a higher prevalence of hip fracture (27% vs 21%, p <0.01).
We included 249 patients for intervention (77% females). The location of the fracture was: forearm (n = 89), femur (n = 52), humerus (n = 45), vertebra (n = 15) and other bones (n = 48). 49 patients (19%) were using bisphosphonate at baseline visit. The DXA was normal in 46 cases (18%) and showed osteopenia in 97 (39%) and OP in 106 (42%). The average FRAX for major fracture was 12±10, with a risk for hip fracture >3% in 45% of cases. After the baseline visit 156 patients were referred to primary care (62%) and 92 patients to rheumatology clinic (37%). In total, antiresorptive treatment was recommended to 172 patients (69%), 167 a bisphosphonate and 5 denosumab. In the follow-up at 3 months, 73% of patients who had been prescribed antiresorptive were receiving treatment.
Conclusions We present the firstmultidisciplinary and multi-professional program for secondary prevention of fractures in Spain. The absolute number of patients who were prescribed antiresorptive increased by three times compared to standard management.
Acknowledgements Grant: Proyecto nacional del Ministerio de Ciencia e Innovación. Instituto de Salud Carlos III: PI11/01429
Disclosure of Interest None Declared