Prevalence and Treatment of Fragility Fractures in Spanish Primary Care: PREFRAOS Study

Overview

Journal Arch Osteoporos

Publisher Springer

Date 2022 Jul 14

PMID 35836031

Authors

Daniel Martinez-Laguna

Cristina Carbonell

Jose-Carlos Bastida

Milagros Gonzalez

Rafael M Mico-Perez

Francisco Vargas

Monica Balcells-Oliver

Laura Canals

Affiliations

Soon will be listed here.

Abstract

Purpose: In Spanish PC, the prevalence of FF is high, especially in women. One-third of subjects with a FF lacked an OP diagnosis and more than half were not currently receiving OP medication. Several studies reported underdiagnosis/undertreatment of OP in PC among elderly subjects with FF. To date, no such data exist for Spain. The purpose is to estimate the prevalence of FF in the elderly population (≥ 70 years old) and to describe the characteristics, risk factors, comorbidities, and OP diagnosis and treatment rates of subjects with FF in Spanish PC centers.

Methods: This is an observational, retrospective study in Spain consisting of two phases. Phase A included all subjects ≥ 70 years old listed in the center's medical records from November 2018 to March 2020. Phase B included subjects with FF and prior consultation at the center for any reason. Subjects were excluded only if they had previously participated in another study. Primary outcomes were prevalence of FF (phase A) and characteristics of subjects with at least one FF (phase B).

Results: The overall prevalence of FF was 17.7% among subjects visiting medical centers for any reason (24.1% women vs. 8.0% men) (30 PC centers from 14 Spanish regions). Vertebral (5.1%) was the most prevalent fracture. Of 665 subjects in phase B, most (87%) were women and ≥ 80 years old (57%), suffered mainly major OP fracture (68%), and had multiple comorbidities (≥ 2, 89.2%). While two-thirds had OP diagnosis and 61.1% received OP medication anytime in the past, 56.8% were not currently receiving OP medication. Diagnosis and treatment rates were lower among men (43% and 38% vs. 70% and 65%, respectively).

Conclusion: Prevalence of FF was high, especially in women. One-third of subjects lacked OP diagnosis and ≥ 50% were not receiving OP treatment; diagnosis and treatment gaps were larger among men. This reinforces the need to improve the management of FF in the elderly population. However, as PC centers participating in this study had high OP experience that have the potential to do better in terms of diagnosis and treatment, caution in the generalization of these data should be taken.

Citing Articles

Real-World Osteoporosis Treatment Gap and Costs in Spain: Data from Women with a First Fragility Fracture or Diagnosis of Postmenopausal Osteoporosis.

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PMID: 39932674 DOI: 10.1007/s40744-024-00743-5.

Secondary fracture prevention in Spanish primary care: results of the PREFRAOS Study.

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Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts.

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Integrating post-fracture care into the primary care setting (interFRACT): Protocol for a mixed-methods study to co-design a care program to improve rates of osteoporosis and fracture treatment.

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References

Harvey N, McCloskey E, Mitchell P, Dawson-Hughes B, Pierroz D, Reginster J . Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int. 2017; 28(5):1507-1529. PMC: 5392413. DOI: 10.1007/s00198-016-3894-y. View

Kanis J, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A . Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int. 2000; 11(8):669-74. DOI: 10.1007/s001980070064. View

Kanis J, McCloskey E, Johansson H, Cooper C, Rizzoli R, Reginster J . European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2012; 24(1):23-57. PMC: 3587294. DOI: 10.1007/s00198-012-2074-y. View

Azagra R, Zwart M, Encabo G, Aguye A, Martin-Sanchez J, Puchol-Ruiz N . Rationale of the Spanish FRAX model in decision-making for predicting osteoporotic fractures: an update of FRIDEX cohort of Spanish women. BMC Musculoskelet Disord. 2016; 17:262. PMC: 4912785. DOI: 10.1186/s12891-016-1096-6. View

Miller P . Underdiagnosis and Undertreatment of Osteoporosis: The Battle to Be Won. J Clin Endocrinol Metab. 2016; 101(3):852-9. DOI: 10.1210/jc.2015-3156. View

Bottai V, Giannotti S, Raffaeta G, Mazzantini M, Casella F, De Paola G . Underdiagnosis of osteoporotic vertebral fractures in patients with fragility fractures: retrospective analysis of over 300 patients. Clin Cases Miner Bone Metab. 2016; 13(2):119-122. PMC: 5119708. DOI: 10.11138/ccmbm/2016.13.2.119. View

McCloskey E, Rathi J, Heijmans S, Blagden M, Cortet B, Czerwinski E . The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study. Osteoporos Int. 2020; 32(2):251-259. PMC: 7838133. DOI: 10.1007/s00198-020-05557-z. View

Skjodt M, Khalid S, Ernst M, Rubin K, Martinez-Laguna D, Delmestri A . Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom. Osteoporos Int. 2020; 31(8):1535-1544. PMC: 7360649. DOI: 10.1007/s00198-020-05358-4. View

Mendis A, Ganda K, Seibel M . Barriers to secondary fracture prevention in primary care. Osteoporos Int. 2017; 28(10):2913-2919. DOI: 10.1007/s00198-017-4131-z. View

10.

Tebe C, Del Rio L, Casas L, Estrada M, Kotzeva A, Di Gregorio S . [Risk factors for fragility fractures in a cohort of Spanish women]. Gac Sanit. 2011; 25(6):507-12. DOI: 10.1016/j.gaceta.2011.06.007. View

11.

Cosman F, de Beur S, LeBoff M, Lewiecki E, Tanner B, Randall S . Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014; 25(10):2359-81. PMC: 4176573. DOI: 10.1007/s00198-014-2794-2. View

12.

Borgstrom F, Karlsson L, Ortsater G, Norton N, Halbout P, Cooper C . Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020; 15(1):59. PMC: 7166207. DOI: 10.1007/s11657-020-0706-y. View

13.

Cawthon P . Gender differences in osteoporosis and fractures. Clin Orthop Relat Res. 2011; 469(7):1900-5. PMC: 3111766. DOI: 10.1007/s11999-011-1780-7. View

14.

Court-Brown C, Caesar B . Epidemiology of adult fractures: A review. Injury. 2006; 37(8):691-7. DOI: 10.1016/j.injury.2006.04.130. View

15.

Sanfelix-Genoves J, Reig-Molla B, Sanfelix-Gimeno G, Peiro S, Graells-Ferrer M, Vega-Martinez M . The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study). Bone. 2010; 47(3):610-6. DOI: 10.1016/j.bone.2010.06.015. View

16.

Pisani P, Renna M, Conversano F, Casciaro E, Di Paola M, Quarta E . Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop. 2016; 7(3):171-81. PMC: 4794536. DOI: 10.5312/wjo.v7.i3.171. View

17.

Martinez-Laguna D, Soria-Castro A, Carbonell-Abella C, Orozco-Lopez P, Estrada-Laza P, Nogues X . Validation of fragility fractures in primary care electronic medical records: A population-based study. Reumatol Clin (Engl Ed). 2017; 15(5):e1-e4. DOI: 10.1016/j.reuma.2017.10.013. View

18.

Caeiro J, Bartra A, Mesa-Ramos M, Etxebarria I, Montejo J, Carpintero P . Burden of First Osteoporotic Hip Fracture in Spain: A Prospective, 12-Month, Observational Study. Calcif Tissue Int. 2016; 100(1):29-39. PMC: 5214753. DOI: 10.1007/s00223-016-0193-8. View

19.

Hurtado I, Garcia-Sempere A, Peiro S, Rodriguez-Bernal C, Sanfelix-Genoves J, Sanfelix-Gimeno G . Trends and Geographical Variability in Osteoporosis Treatment After Hip Fracture: A Multilevel Analysis of 30,965 Patients in the Region of Valencia, Spain. J Bone Miner Res. 2020; 35(9):1660-1667. PMC: 9328445. DOI: 10.1002/jbmr.4028. View

20.

Prieto-Alhambra D, Reyes C, Sanz Sainz M, Gonzalez-Macias J, Delgado L, Alonso Bouzon C . In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study. Arch Osteoporos. 2018; 13(1):96. PMC: 6153683. DOI: 10.1007/s11657-018-0515-8. View