Llopis-Cardona Fran, Rodríguez-Bernal Clara L, Hurtado Isabel, Espallargues Mireia, García Nekane, Gorostiza Iñigo, Gorricho Javier, Librero Julián, Millán Eduardo, Modroño Gracia, Parraza Naiara, Sanfélix-Gimeno Gabriel
Health Services Research and Pharmacoepidemiology Unit, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain.
Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.
Osteoporos Int. 2025 Jul 12. doi: 10.1007/s00198-025-07564-4.
Treatment with antiosteoporotics is recommended after a hip fracture to reduce the risk of a new fracture or death. In our study, we found a slight increase in treatment rates over time, but an important treatment gap in the contemporary secondary prevention of hip fracture is still present.
The pharmacological management of patients after hip fracture is likely to have changed due to the availability of denosumab during the last decade, but the extent of its use and potential improvement in treatment rates in routine clinical practice is largely unknown.
We constructed a population-based retrospective cohort of all patients aged 65 years + , discharged alive following hip fracture hospitalization (Jan 2008 to Dec 2021) in several regions of Spain, accounting for one third of the country's population. The proportion of patients prescribed any antiosteoporotic (AO) medication and specific classes in the first 90 days after discharge was evaluated. Temporal trends of treatment prescription per month were plotted. All analyses were performed also by age, sex, and region.
In a cohort of over 120,000 patients, we found an important treatment gap in the secondary prevention of hip fracture (78% of patients untreated). Bisphosphonates and denosumab accounted for 60% and 20% of the AO prescriptions, respectively. Treatment gaps were most pronounced among patients aged 85 and over, and males: 26% of patients aged ≤ 84 were treated, in contrast to 18% of those aged 85 + . The proportion of females treated nearly doubled that of males (24% vs 14%). Differences by region were observed. Regarding time trends, despite finding an increase over time, prescription rates remained highly suboptimal. By drug class, treatment with bisphosphonates dropped, whereas denosumab treatment rose along the study period. Concerning management by sex, the Mediterranean regions showed a persistent gap over time, whereas in the Northern regions, the gap was gradually reduced. Treatment patterns by age groups were consistent over time.
Our study offers evidence to identify current gaps of care in secondary prevention of hip fracture and implement adequate strategies to reduce recurrent fractures in this frail population.
髋部骨折后建议使用抗骨质疏松药物治疗，以降低再次骨折或死亡的风险。在我们的研究中，我们发现治疗率随时间略有上升，但在当代髋部骨折二级预防中仍存在重要的治疗差距。
由于过去十年中地诺单抗的可用性，髋部骨折患者的药物治疗可能已经发生变化，但在常规临床实践中其使用程度和治疗率的潜在改善情况在很大程度上尚不清楚。
我们构建了一个基于人群的回顾性队列，纳入西班牙几个地区所有65岁及以上、髋部骨折住院后存活出院（2008年1月至2021年12月）的患者，这些地区占该国人口的三分之一。评估出院后前90天内开具任何抗骨质疏松（AO）药物和特定类别药物的患者比例。绘制每月治疗处方的时间趋势图。所有分析也按年龄、性别和地区进行。
在超过120,000名患者的队列中，我们发现髋部骨折二级预防中存在重要的治疗差距（78%的患者未接受治疗）。双膦酸盐和地诺单抗分别占AO处方的60%和20%。治疗差距在85岁及以上患者和男性中最为明显：≤84岁患者中有26%接受了治疗，而85岁及以上患者中这一比例为18%。接受治疗的女性比例几乎是男性的两倍（24%对14%）。观察到地区差异。关于时间趋势，尽管发现随时间有所增加，但处方率仍远未达到最佳水平。按药物类别来看，双膦酸盐治疗有所下降，而地诺单抗治疗在研究期间有所上升。按性别管理方面，地中海地区随着时间推移持续存在差距，而在北部地区，差距逐渐缩小。各年龄组的治疗模式随时间保持一致。
我们的研究为识别当前髋部骨折二级预防中的护理差距以及实施适当策略以减少这一脆弱人群的复发性骨折提供了证据。
