Conclusions All interventions produced positive effects on BMD scanning and osteoporosis treatment rates post-fracture .
Despite sizeable increases , investigation and treatment rates remain sub-optimal .
Background There is a large quality of care gap for patients with osteoporosis .
As a fragility fracture is a strong indicator of underlying osteoporosis , it offers an ideal opportunity to initiate investigation and treatment .
However , studies of post-fracture population s document screening and treatment rates below 20 % in most setting s. This is despite the fact that bone mineral density ( BMD ) scans are effective at identifying patients at high risk of fracture , and effective drug treatments are widely available .
Effective interventions are required to remedy this incongruity in current practice .
A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group.
PURPOSE We conducted a 5-year , double-blind , r and omized , placebo-controlled study to determine whether salmon calcitonin nasal spray reduced the risk of new vertebral fractures in postmenopausal women with osteoporosis . SUBJECTS AND METHODS A total of 1,255 postmenopausal women with established osteoporosis were r and omly assigned to receive salmon calcitonin nasal spray ( 100 , 200 , or 400 IU ) or placebo daily . All participants received elemental calcium ( 1,000 mg ) and vitamin D ( 400 IU ) daily . Vertebral fractures were assessed with lateral radiographs of the spine . The primary efficacy endpoint was the risk of new vertebral fractures in the salmon calcitonin nasal spray 200-IU group compared with the placebo group . RESULTS During 5 years , 1,108 participants had at least one follow-up radiograph . A total of 783 women completed 3 years of treatment , and 511 completed 5 years . The 200-IU dose of salmon calcitonin nasal spray significantly reduced the risk of new vertebral fractures by 33 % compared with placebo [ 200 IU : 51 of 287 , placebo : 70 of 270 , relative risk ( RR ) = 0.67 , 95 % confidence interval ( CI ) : 0.47- to 0.97 , P = 0.03 ] . In the 817 women with one to five prevalent vertebral fractures at enrollment , the risk was reduced by 36 % ( RR = 0.64 , 95 % CI : 0.43- to 0.96 , P = 0.03 ) . The reductions in vertebral fractures in the 100-IU ( RR = 0.85 , 95 % CI : 0.60- to 1.21 ) and the 400-IU ( RR = 0.84 , 95 % CI : 0.59- to 1.18 ) groups were not significantly different from placebo . Lumbar spine bone mineral density increased significantly from baseline ( 1 % to 1 . 5 % , P<0.01 ) in all active treatment groups . Bone turnover was inhibited , as shown by suppression of serum type-I collagen cross-linked telopeptide ( C-telopeptide ) by 12 % in the 200-IU group ( P < 0.01 ) and by 14 % in the 400-IU group ( P<0.01 ) as compared with placebo . CONCLUSION Salmon calcitonin nasal spray at a dose of 200 IU daily significantly reduces the risk of new vertebral fractures in postmenopausal women with osteoporosis
Conclusions All interventions produced positive effects on BMD scanning and osteoporosis treatment rates post-fracture .
Despite sizeable increases , investigation and treatment rates remain sub-optimal .
Background There is a large quality of care gap for patients with osteoporosis .
As a fragility fracture is a strong indicator of underlying osteoporosis , it offers an ideal opportunity to initiate investigation and treatment .
However , studies of post-fracture population s document screening and treatment rates below 20 % in most setting s. This is despite the fact that bone mineral density ( BMD ) scans are effective at identifying patients at high risk of fracture , and effective drug treatments are widely available .
Effective interventions are required to remedy this incongruity in current practice .