TY - JOUR

T1 - Treatment of high fracture risk patients in routine clinical practice

AU - Lesnyak, Olga

AU - Gladkova, Elena

AU - Aleksandrov, Nikolay

AU - Belaya, Zhanna

AU - Belova, Ksenia

AU - Bezlyudnaya, Natalya

AU - Dobrovolskaya, Olga

AU - Dreval, Alexandr

AU - Ershova, Olga

AU - Grebennikova, Tatiana

AU - Kryukova, Irina

AU - Mazurenko, Sergey

AU - Priymak, Diana

AU - Rozhinskaya, Ludmila

AU - Samigullina, Rusanna

AU - Solodovnikov, Alexander

AU - Toroptsova, Natalya

N1 - Publisher Copyright: © 2020, International Osteoporosis Foundation and National Osteoporosis Foundation.

PY - 2020/12

Y1 - 2020/12

N2 - Summary: A retrospective cohort study determined the high incidence of recurrent fractures in osteoporotic patients with high fracture risk during the observation. The strategy of starting treatment with more potent regimens (zoledronic acid, denosumab and/or teriparatide) seems to have the best secondary fracture prevention efficacy. Objective: This paper describes the various medical therapy regimens prescribed to osteoporotic patients with high fracture risk and the result of treatment. Methods: We carried out a retrospective cohort study in selected Osteoporosis Centers. Patients were considered to have high fracture risk in case of a history of a low-energy hip fracture or two or more vertebral or other site fractures. A total of 812 subjects (768 women and 44 men) aged 36–95 years were included. The observation period was 2285.1 patient-years. Demographic data, clinical findings, and BMD data obtained by DXA, as well as a history of fractures that had occurred during the follow-up, were included in the analysis. Results: Overall, at baseline, there were 637 non-vertebral fractures including 104 hip fractures. A total of 590 patients had vertebral fractures; of these, 69% suffered multiple fractures. Being on treatment, 119 (14.7%) patients developed new vertebral and non-vertebral fractures. The incidence of new non-vertebral fractures and hip fractures was 39.4 and 13.1 per 1000 patient-years. The total number of vertebral fractures increased by 24.8% from 1353 to 1689. The best results of the treatment were achieved in patients who were started on zoledronic acid, denosumab, or teriparatide and had an adequate duration of treatment. Although these patients had significantly lower BMD values at the time of diagnosis compared with other patients, they showed a lower incidence of new vertebral and hip fractures, during the follow-up. Conclusion: Therapy of patients at high risk of fractures started with more potent treatment regimens (zoledronic acid, denosumab and/or teriparatide) of adequate duration was more effective in terms of prevention of new vertebral and hip fractures as compared with other treatment options. However, treatment appears to be challenging given the number of recurrent fractures in patients on treatment and the frequency of drug withdrawal or replacement.

AB - Summary: A retrospective cohort study determined the high incidence of recurrent fractures in osteoporotic patients with high fracture risk during the observation. The strategy of starting treatment with more potent regimens (zoledronic acid, denosumab and/or teriparatide) seems to have the best secondary fracture prevention efficacy. Objective: This paper describes the various medical therapy regimens prescribed to osteoporotic patients with high fracture risk and the result of treatment. Methods: We carried out a retrospective cohort study in selected Osteoporosis Centers. Patients were considered to have high fracture risk in case of a history of a low-energy hip fracture or two or more vertebral or other site fractures. A total of 812 subjects (768 women and 44 men) aged 36–95 years were included. The observation period was 2285.1 patient-years. Demographic data, clinical findings, and BMD data obtained by DXA, as well as a history of fractures that had occurred during the follow-up, were included in the analysis. Results: Overall, at baseline, there were 637 non-vertebral fractures including 104 hip fractures. A total of 590 patients had vertebral fractures; of these, 69% suffered multiple fractures. Being on treatment, 119 (14.7%) patients developed new vertebral and non-vertebral fractures. The incidence of new non-vertebral fractures and hip fractures was 39.4 and 13.1 per 1000 patient-years. The total number of vertebral fractures increased by 24.8% from 1353 to 1689. The best results of the treatment were achieved in patients who were started on zoledronic acid, denosumab, or teriparatide and had an adequate duration of treatment. Although these patients had significantly lower BMD values at the time of diagnosis compared with other patients, they showed a lower incidence of new vertebral and hip fractures, during the follow-up. Conclusion: Therapy of patients at high risk of fractures started with more potent treatment regimens (zoledronic acid, denosumab and/or teriparatide) of adequate duration was more effective in terms of prevention of new vertebral and hip fractures as compared with other treatment options. However, treatment appears to be challenging given the number of recurrent fractures in patients on treatment and the frequency of drug withdrawal or replacement.

KW - Osteoporosis

KW - High fracture risk

KW - Clinical practice

KW - Treatment

KW - Fractures

KW - EFFICACY

KW - PREVENTION

KW - TERIPARATIDE

KW - SUBSEQUENT FRACTURE

KW - DOUBLE-DUMMY

KW - OSTEOPOROSIS

KW - ALENDRONATE

KW - DOUBLE-BLIND

KW - QUALITY-OF-LIFE

KW - POSTMENOPAUSAL WOMEN

UR - http://www.scopus.com/inward/record.url?scp=85096381298&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/05a4e013-7581-3940-be3b-8736918f63ac/

U2 - 10.1007/s11657-020-00851-z

DO - 10.1007/s11657-020-00851-z

M3 - Article

VL - 15

JO - Archives of Osteoporosis

JF - Archives of Osteoporosis

SN - 1862-3522

IS - 1

M1 - 184

ER -