In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term.

BackgroundAlthough management of osteoporosis (OP) is cost-effective in high-risk patients, less than 20% of patients with fragility fracture receive antiresorptive drugs and more than 50% stop treatment after a year.ObjectivesThe main objective was to evaluate the long-term adherence to treatment of a program for secondary prevention of OP fracturesMethodsPatients >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, 3) baseline visit: questionnaire by the nurse, bone densitometry and patient education; 4) clinical report referral to primary care or rheumatology (those with multiple fractures or requiring special therapy); and 5) follow-up through a phone survey and checking the prescriptions in electronic records. The outcome of the program was analysed 2 years after implementation, including 1) percentage of attendees/eligible; 2) percentage of attendees who start treatment with bisphosphonates; 3) percentage of patients who retain treatment after 6, 12,18 and 24 months; and 4) factors associated to adherence.ResultsAfter 2 years of implementation, the program detected 1674 patients, of whom 759 finally entered the program (57% of eligible). After 3 months, 52% of the patients (82% of those with prescribed antiresorptive) in the program started treatment. Factors associated with starting treatment at 3 months were female sex (85% vs 71%; p=0.01), previous treatment with antiresorptive (91% vs 80%; p=0.02), hip fracture (89% vs forearm 75%; p=0.007) and being attended by a rheumatologist (89% vs primary care 69%; p<0.001). Adherence to treatment at 6, 12 and 18 months among those who had prescribed treatment with bisphosphonates was 73%, 71% and 73% respectively. We only have data of 50 patients with 24 months follow-up, 72% of them were on treatment. Factors associated with adherence at 12 months were female sex and previous treatment with antiresorptive (Table).The causes of withdrawal of treatment at 12 months in 83 phoned patients were as follows: 25 patients do not agree to take treatment, 24 patients by unknown reasons, 18 stopped or not started by primary care doctor, 8 because gastrointestinal complaints, 5 because of being taking many drugs, and 3 because others diseases.Table 1All patientsSexFractureStarted treatmentPrevious use of bisphosphonateTreatment prescribedWomenMenHipForearmRheumatologyPrimary careYesNoOral biphosphonatesDenosumabContinued treatment71.3%76%45%69%68%74%69%86%68%71%88%Stopped or not initiated treatment28.7%24%55%31%32%26%31%14%32%29%12%P<0.0010.910.320.0020.06 ConclusionsIn Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology is effective in terms of recruitment of patients and adherence to treatment in the long-term.AcknowledgementsProyecto nacional del Ministerio de Ciencia e Innovaciόn. Instituto de Salud Carlos III: PI11/01429Disclosure of InterestNone d...