Endocrine Abstracts (2019) 64 018 | DOI: 10.1530/endoabs.64.018

Osteoporosis treatment gap in the FRISBEE cohort

C Smeys, L Iconaru, V Kinnard, F Baleanu, M Moreau, P Bergmann & J-J Body



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 60–85 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.

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