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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

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
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

This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed.

INTRODUCTION: Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015.

METHODS: This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture.

RESULTS: A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women.

CONCLUSION: Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

Fracture prevention, Health Services Research
0937-941X
1535-1544
Skjodt, M K
c57ef821-0d62-4d91-909b-4f32a9f9299d
Khalid, S.
30756044-0ed2-4b5d-b230-2b389b0914c8
Ernst, M.
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Rubin, K.H.
66714a0c-f157-4539-833f-80279abeaa33
Martínez-Laguna, Daniel
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Delmestri, A.
c1dfbd4f-1ec0-4e02-a6fa-423f90edc322
Kassim Javaid, M.
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Cooper, Cyrus
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Libanati, Cesar
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Toth, Emese
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Abrahamsen, B.
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Prieto-Alhambra, D
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Skjodt, M K
c57ef821-0d62-4d91-909b-4f32a9f9299d
Khalid, S.
30756044-0ed2-4b5d-b230-2b389b0914c8
Ernst, M.
577e5b64-aa72-47d1-8093-7b1f9a27dc76
Rubin, K.H.
66714a0c-f157-4539-833f-80279abeaa33
Martínez-Laguna, Daniel
330a147f-0b3a-41ff-8550-3dae76ac8ab2
Delmestri, A.
c1dfbd4f-1ec0-4e02-a6fa-423f90edc322
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Libanati, Cesar
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Toth, Emese
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Abrahamsen, B.
fee8b1eb-c267-4d2a-952a-d1b9f20d0125
Prieto-Alhambra, D
051113cd-2da1-4e0d-aa4b-d7b1fe63cd12

Skjodt, M K, Khalid, S., Ernst, M., Rubin, K.H., Martínez-Laguna, Daniel, Delmestri, A., Kassim Javaid, M., Cooper, Cyrus, Libanati, Cesar, Toth, Emese, Abrahamsen, B. and Prieto-Alhambra, D (2020) 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. Osteoporosis International, 31 (8), 1535-1544. (doi:10.1007/s00198-020-05358-4).

Record type: Article

Abstract

This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed.

INTRODUCTION: Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015.

METHODS: This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture.

RESULTS: A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women.

CONCLUSION: Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.

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Accepted/In Press date: 18 February 2020
e-pub ahead of print date: 17 March 2020
Published date: 1 August 2020
Additional Information: Funding Information: UCB funded this study. All analyses were conducted independently by the academic researchers involved. MKJ is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). Funding Information: MKS has institutional research contract with UCB and educational grant from UCB. SK has nothing to disclose. ME has institutional research contract with UCB. KHR has nothing to disclose. DML received personal fees from Amgen, Eli Lilly, Novartis, Ferrer, and Rubió. AD reports grants from UCB during the conduct of the study. MKJ received honoraria, unrestricted research grants, and travel and/or subsistence expenses from Amgen and UCB. CC received personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. CL and ET are employees of UCB Pharma. BA has institutional research contracts with Novartis and UCB with funds paid to the institution and received speaker fees from Amgen and personal consultancy fees from UCB and Kyowa-Kirin UK. DPA received institutional research grants from UCB and Amgen, grant from Les Laboratoires Servier, educational grants from Johnson & Johnson, and speaker and consultancy fees paid to his department by Amgen and UCB. Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organized by DPA’s department and open for external participants. Publisher Copyright: © 2020, The Author(s).
Keywords: Fracture prevention, Health Services Research

Identifiers

Local EPrints ID: 438992
URI: http://eprints.soton.ac.uk/id/eprint/438992
ISSN: 0937-941X
PURE UUID: e348115d-cf8d-4324-a9e3-9eb2743a7208
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 31 Mar 2020 16:31
Last modified: 21 Sep 2022 01:35

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Contributors

Author: M K Skjodt
Author: S. Khalid
Author: M. Ernst
Author: K.H. Rubin
Author: Daniel Martínez-Laguna
Author: A. Delmestri
Author: M. Kassim Javaid
Author: Cyrus Cooper ORCID iD
Author: Cesar Libanati
Author: Emese Toth
Author: B. Abrahamsen
Author: D Prieto-Alhambra

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