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

UNLABELLED: 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.