Background/Purpose: Evidence shows that of ten patients taking medication against osteoporosis one will avoid subsequent fractures, decreasing the risk by > 50 %. On the other hand, epidemiologic studies indicate that merely 15 – 30 % of the affected cases are initiated on adequate therapy. 

Methods: All cases over fifty years of age admitted to the traumatology department with a fracture were investigated with osteodensitometry and standard of care laboratory parameters. A questionnaire was provided to gather data in a quality assurance program. Therapy was recommended according to the FRAX validated for Switzerland. One year after the fracture, the patients and their family physicians were invited to answer a questionnaire targeted at evaluating compliance with the recommendation provided after discharge from the hospital.

Results: 101 of 127 patients that we were able to contact answered the query (79%; median 72 years, 80% females; 83% low-energy trauma). 54% stated that they regularly took a specific medication against osteoporosis. 66 % were supplemented with vitamin D and 67 % with calcium. 30 % were on all three medications. Reasons given by 41 % of the patients for not taking medication were lack of prescription by the treating physician, 17 % considered the treatment unnecessary, 4 % indicated a lack of interest. Financial reasons, drug intolerance, old age and illness were each given as reasons by 2 %. Other reasons were given in 22 %.

Family physicians stated that in 87 % and 75 % prescriptions were given for vitamin D and calcium supplementation, respectively, for specific therapy in 58 % and a combination of all three in 42 %. Reasons for failure to prescribe medications were lack of interest in 18 %, insufficient confidence in the therapeutic recommendation therapy in 10 %, insufficient information about the therapy in 12 % and other reasons including intolerance or morbidity (20 % of other reasons). There was significant divergence between the reasons given by patients and treating physicians (p<0.001).

Conclusion: One year after an osteoporotic fracture at most half of the patients were taking adequate medication against osteoporosis. Though this result is higher than those reported in the literature, the indicated lack of information and the discrepancy between the reasons given by the patients and their family physicians provide the scope for optimization with improvements in communication and information.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/twelve-months-after-osteoporosis-associated-fracture-has-adequate-therapy-been-initiated/