Service de Rhumatologie, Hopital Nord - Place Victor Pauchet, CHU Amiens, Université de Picardie - Jules Verne, 80054, Amiens Cedex, France.
Certara, Paris, France.
Arch Osteoporos. 2022 Feb 3;17(1):29. doi: 10.1007/s11657-021-01041-1.
The use of anti-osteoporosis treatment following a diagnosis of osteoporosis with fracture or a relevant fragility fracture remains low in France. Initiating an anti-resorptive may reduce the incidence of a subsequent fracture by 60%.
To describe real-world osteoporosis treatment patterns in individuals with a fragility fracture in France and to explore the impact of initiating treatment on the risk of subsequent fracture.
A retrospective cohort study, using the national French Health Insurance claims database. Males and females 50 years and over, with a hospital discharge diagnosis of osteoporosis with fracture or a relevant fragility fracture between 2011 and 2014, were included and followed until death or the end of 2016, whichever came first. The primary outcome was the proportion of patients receiving anti-osteoporosis treatments prior to and post-index fracture. Change in fracture rates before and after treatment initiation was assessed in an exploratory analysis.
A total of 574,133 patients (138,567 males, 435,566 females) had a qualifying index fracture. The proportion of patients receiving any anti-osteoporosis treatment increased pre-index fracture to post-index fracture from 2.2 to 5.6% among males, and from 11.8 to 18.2% among females. Oral bisphosphonates were the most prescribed anti-osteoporosis treatment for both males and females among post-index fractures (60.6% and 68.8% of patients initiating treatment). Following initiation of anti-resorptives, the incidence of subsequent fracture was reduced by 60% (rate ratio (RR): 0.40, 95% confidence interval [CI]: 0.34-0.45).
Anti-osteoporosis treatment following an index fracture in France remains low. Improved identification and pharmacologic management of patients at risk of fragility fractures are necessary to reduce the risk of subsequent fractures.
描述法国脆性骨折患者的真实世界骨质疏松治疗模式，并探讨起始治疗对后续骨折风险的影响。
这是一项回顾性队列研究，使用的是法国国家健康保险索赔数据库。纳入 2011 年至 2014 年间因骨质疏松性骨折或相关脆性骨折住院诊断的年龄≥50 岁的男性和女性患者，并随访至死亡或 2016 年底，以先发生者为准。主要结局是在索引骨折前和后接受抗骨质疏松治疗的患者比例。在探索性分析中评估了起始治疗前后骨折发生率的变化。
共纳入 574133 例患者（男性 138567 例，女性 435566 例）发生符合条件的索引骨折。男性患者索引骨折前和后接受任何抗骨质疏松治疗的比例从 2.2%增至 5.6%，女性患者从 11.8%增至 18.2%。在索引骨折后，男性和女性中最常开具的抗骨质疏松药物是口服双膦酸盐（起始治疗的患者中分别有 60.6%和 68.8%）。起始抗吸收剂治疗后，后续骨折的发生率降低了 60%（率比（RR）：0.40，95%置信区间[CI]：0.34-0.45）。
法国在发生索引骨折后抗骨质疏松治疗仍不充分。有必要改进对脆性骨折高危患者的识别和药物管理，以降低后续骨折的风险。
