Effectiveness of pharmacological treatment in the secondary prevention of fragility fractures: A region-wide study.

BACKGROUND AND

OBJECTIVE

Pharmacological treatment of fragility fractures is a strategy used to prevent secondary fractures. Our aim was to evaluate its effectiveness through a real-world data study in the population of the Basque Country (Spain).

MATERIALS AND

METHODS

An observational real-world data design was used, with the target population being documented cases of osteoporotic fracture (humerus, hip, vertebra or wrist) in Osakidetza-the Basque Health Service between 1 January 2016 and 31 December 2023, in patients aged over 60 years, and the outcome of interest was a secondary fracture. Patients receiving pharmacological treatment (bisphosphonates, selective oestrogen receptor modulators, denosumab and/or anabolic agents) were compared with untreated patients using propensity score and survival analysis (Kaplan-Meier curves and Cox regression).

RESULTS

The total target population analysed was 56,218 cases of first fracture, of which 22,649 were hip, 8150 were humerus, 12,833 were wrist and 12,586 were vertebral fractures. Treatment coverage was low (20.00%). Treatment was effective overall for all fractures, with a hazard ratio (HR) of 0.902 (confidence intervals [CIs] 0.881-0.924), and for first fractures of the humerus (HR: 0.698; CI: 0.643-0.758), vertebra (HR: 0.819; CI: 0.785-0.855) and wrist (HR: 0.765; CI: 0.726-0.806), but not for hip fractures (HR:1.113; CI: 1.070-1.158).

CONCLUSION

Fracture prevention was effective in reducing the risk of a second fracture. Notable differences were observed by first fracture type, treatment being ineffective for hip fractures. Furthermore, treatment coverage must be increased in order to reap the full benefits of secondary prevention at a population level.