Abstract
PurposeFragility fractures are a clinical consequence of osteoporosis (OP). Evidence suggests however, current OP treatments may be inadequate in reducing fracture risk. The purpose of this study was to estimate the proportion and characteristics of Swedish patients who remain at high risk of fracture after 2 years of treatment, as evidenced by osteoporotic bone mineral density (BMD), a decrease in BMD, or the occurrence of new fractures. MethodsThis was a retrospective, descriptive analysis of a subset of participants obtained from a Swedish osteoporosis patient registry from 1991 to 2009. Patients were required to be osteoporotic, to be treatment naive at baseline, to have returned for at least 1 follow-up visit, and to have reported osteoporosis treatment use for ≥2 years after the baseline visit with a BMD T score. Two overlapping cohorts remaining at high risk of fracture were defined using the BMD T score measured after 2 years of treatment from baseline. The osteoporosis cohort comprised patients who remained osteoporotic, whereas the BMD decrease cohort included patients whose total hip or lumbar spine T score decreased by ≥3%. FindingsA total of 3292 osteoporotic patients were identified in the registry, of whom 392 met the study inclusion criteria. The mean (SD) patient age was 68.3 (8.5) years, with most patients being female (92.3%). Among all patients, 297 (75.8%) remained osteoporotic after at least 2 years of treatment, 90 (23.0%) experienced a BMD decrease of ≥3%, and 23 (5.9%) reported an incident fracture between the baseline and first follow-up visit. More than three-quarters (76.8%) of all patients reported taking bisphosphonates, whereas only 72.4% and 47.8% reported this in the osteoporosis and BMD decrease cohorts, respectively. Raloxifene was the only nonbisphosphonate used, with 24.2% of all patients reportedly taking it. ImplicationsThis study highlighted that despite 2 years of osteoporosis treatment, a high percentage of patients remain at high risk of fracture. There is a need for improved treatment strategies that reduce fracture risk and improve patient outcomes in the real-world setting.
Highlights
Osteoporosis is a skeletal disorder characterized by compromised bone strength and disruption of bone architecture that results in increased risks of fragility fractures, representing the predominant clinical consequence of osteoporosis
This study provides real-world evidence on the proportion of Swedish patients who remain at high risk of fracture after 2 years of active osteoporosis treatment
Patients were assessed as high risk of fracture after treatment based on an osteoporotic bone mineral density (BMD) T score, a decrease in BMD T score, or the presence of a fracture
Summary
Osteoporosis is a skeletal disorder characterized by compromised bone strength and disruption of bone architecture that results in increased risks of fragility fractures, representing the predominant clinical consequence of osteoporosis. Fragility fractures contribute to the significant societal burden through the loss in quality of life attributable to associated pain, disability, substantial incremental health care costs, and higher mortality.[1]. By 2025, the annual fracture incidence is expected to increase by 26% to 135,000, primarily as a function of an aging population.[3] The health care costs associated with osteoporosis in Sweden are substantial. In 2005, the total annual fracture-related costs were estimated at 3.2% of total Swedish health care costs.[4] The economic burden is expected to continue to increase in Sweden from an estimated €1.5 billion in 2010 to €1.8 billion by 2025, an increase of 23%.3
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