PMS74 - THE ROLE OF MONITORING COMPLIANCE TO GUIDELINES IN PREVENTING THE RISK OF SECOND FRACTURE AND DEATH IN PATIENTS WITH OSTEOPOROSIS: A RETROSPECTIVE ADMINISTRATIVE DATABASE ANALYSIS.

Abstract

To assess the relationship between osteoporosis-related pharmacological treatment use, patterns and adherence and risk of second fracture or death in an Italian real-world setting. A retrospective cohort analysis using a north-eastern Italian region’s administrative database was conducted. Osteoporotic patients with a first hospitalization for fracture of femur with replacement or vertebral column between 1 January 2011 and 30 June 2015 were included. The use of post-fracture treatment, treatment patterns, among antiosteoporosis medication (AOM) and supplementation with calcium or vitamin D (Ca/VitD), and adherence using Medication Possession Ratio(MPR) were analyzed. Cox regression models were used to estimate the risk of incidence of osteoporosis-related re-fractures, among femur with replacement, vertebral column, radius and ulna, and all-cause death from the hospitalization-index until 30 June 2016. Follow-up costs were calculated per patient per year (PPPY). 7,391 patients had a first fracture, mean (SD) age was 80 (10) years, 89% were female.After the hospitalization-index, 5,702 (71.9%) patients had osteoporosis-related treatment: 380 (4.8%) had AOM only, 2,549 (32.1%) AOM and Ca/VitD and 2,773 (35.0%) Ca/VitD only. Over a median follow-up of 2.3 years, re-fracture rate was 27/1000 patient-years and death rate was 105/1000 patient-years. Risk of re-fracture decreased among treated patients(HR=0.42, 95%CI 0.35-0.51), those withCa/VitD in addition to AOM (HR=0.64, 95%CI 0.43-0.94) and those adherent (MPR≥80%) to treatment (HR=0.16, 95%CI 0.11-0.24). Risk of mortality decreased among treated patients (HR=0.38, 95%CI 0.34-0.41), those with AOM and Ca/VitD (HR=0.41, 95%CI 0.33-0.50)and increased for adherent patients(HR=1.63, 95%CI 1.38-1.92). On average,PPPY costs resulted €6,884.75 among not treated patients, and €5,477.71, €4,258.16 and €4,626.03,for AOM only, AOM and Ca/VitD and Ca/VitD only groups, respectively. This real-world study suggests that the relevance of monitoring of compliance to guidelines in terms of treatment use, patterns and adherence may improve patients' prognosis.