Introduction: Osteoporosis is characterized by a low bone mass and a microarchiterctural disruption. Ageing and estrogen deficiency are the two most important factors for developing osteoporosis. With advanced age the balance between bone formation and resorption becomes progressively negative and non-bone factors contribute to the increased fracture risk with advancing age. Osteoporotic fractures constitute a major cause of morbidity and mortality in the elderly. Post-menopausal fracture risk is more than 40%, accounting for a high morbidity and mortality. Although effective anti-osteoporotic drugs have been available for decades, treatment gap remains at about 80% but the causes of this alarming treatment gap remain poorly understood and are probably multifactorial.
Objectives: The primary objective of our study was to determine the proportion of patients who did not receive a medication to treat osteoporosis after a first validated osteoporotic fracture in a prospective cohort of volunteer post-menopausal women.
Methods: The FRISBEE cohort consists of 3560 post-menopausal women aged 6085 years at inclusion surveyed yearly for the occurrence of fragility fractures. We examined if a pharmacological treatment was initiated within 2 years after a first radiologically validated fragility fracture occurring during follow-up. We conducted separate analyses for the four classical major osteoporotic fractures (MOFs: vertebra, hip, shoulder/upper arm and wrist), and for other major fractures (ankle, pelvis and sacrum, elbow, knee-except patella, upper- and lower-leg, upper- and lower-arm).
Results: For 386 fractures (285 MOFs and 101 other major fractures), the global percentage of untreated women was 84.9%: 82.8% for MOFs (72.5% (29/40) for the hip, 70.5% (67/95) for the vertebra, 91.7% (44/48) for the shoulder, 94.1% (96/102) for the wrist) and 91.1% for the other major fractures.
Conclusion: Our study indicates that the treatment gap in cohort of Belgian subjects who present an osteoporotic fracture has not improved over time and is similar to other population-based studies. More importantly, these data obtained in volunteer women suggest that the main culprit of this therapeutic failure is the doctor and not the patient.
21 Oct 2019
Belgian Endocrine Society