AB0858 MAINLY MEN, AND OLDER PEOPLE, WITH FRAGILITY HIP FRACTURE DO NOT RECEIVE ANTIOSTEOPOROTIC TREATMENT
Authors: Paloma Vela-Casasempere, Marta Elvira, Antonio Palazon Bru, Silvia Gomez-Sabater, Rocio Caño-Alameda
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients, with considerable economic implications. More than 20% of individuals experience a subsequent hip fracture in the following year (1,2). Although there are effective treatments in the prevention of fractures, the proportion of patients who start treatment after a fragility fracture is low, having decreased in recent years (3). <h3>Objectives</h3> The aim of the study is to know the percentage of patients who received medical treatment for osteoporosis after a fragility hip fracture in our health department. Secondary, we want to know the mortality and re-fracture rates two years after the fracture. <h3>Methods</h3> Cross-sectional retrospective observational study. Patients discharged during 2015 with diagnosis of "Fragility Hip Fracture" were reviewed, data collected through electronic medical record. Variables: sex; age; age and date of death; treatment (calcium, vitamin D or antiosteoporotic drugs) before and after discharge; Fragility fracture before and after hospital discharge. Statistical methods: absolute and relative frequencies for qualitative variables, means and standard deviations for quantitative. Associations between variables were studied using Chi square and T-student test. <h3>Results</h3> A total of 320 patients were obtained, 17 discarded (3 other fracture locations, 1 duplicate, 6 high energy trauma fractures and 8 had other pathologies than osteoporosis that justified the fracture). Mean age was 83.3 ± 7,9 years, 223 (73.6%) women. Prior to admission, 43 patients (14%) took calcium and/or vitamin D, 10 (3%) some antiosteoporotic drug and 20 (7%) both. 230 patients (76%) did not receive treatment. 102 exitus (33.7%) occurred in the 2 years after the fracture. In the post-discharge analysis, 30 patients were discarded (17 died during admission and 13 in the subsequent month), since it was not possible for them to be treated. After discharge, 49 patients (18%) receive Calcium and/or Vitamin D, 15 (5%) some antiosteoporotic drug and 37 (14%) both, leaving 172 patients (63%) without treatment. There were 12 new hip fractures (4.0%). There is a greater proportion of deaths in men (43.8% vs. 30% in women, p = 0.026) and in patients not treated before the fracture (33.2% vs 11.6% calcium-Vit D, p &lt;0.001, 30.5% vs 9.4%, antiosteoporotic treatment p = 0.002). The multivariate analysis found lower probability of having received treatment in men (RR 0.34 IC 95% (0.16-0.72), p = 0.005) and with more age (RR 0.95 IC 95% (0.92-0.98), p = 0.004). After correcting with age: the risk of death in men is 83% higher than in women (p = 0.035). The probability of exitus increases by 10% for each additional year of life. Treatment with calcium and/or vitamin D after discharge is a protective factor against mortality from any cause (p = 0.037). <h3>Conclusion</h3> Percentage of patients receiving drug treatment after suffering an osteoporotic hip fracture is very low. This is accentuated in males, and at an older age, populations that also have higher mortality rates in the two years after the fracture. <h3>Reference</h3> [1] Weaver J, et al. Prevalence and Cost of Subsequent Fractures Among U.S. Patients with an Incident Fracture. J Manag Care Spec Pharm 2017; 23:461-71. [2] León-Vázquez F, et al. Prevención de fractura osteoporótica en España: uso de fármacos antes y después de una fractura de cadera. Rev Osteoporos Metab Miner 2015; 7:54- 23 [3] Van der Velde R.Y., et al. Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: variation by age, sex, geographic lication and ethnicity. Bone. 2017; 94: 50-55. <h3>Disclosure of Interests</h3> Paloma Vela-Casasempere Grant/research support from: UCB, Abbvie, Pfizer, Roche, Bristol-Myer-Squibb (another research, not BIOBADASER related), Consultant for: UCB, Lilly, Pfizer, Roche, Bristol-Myer-Squibb, Speakers bureau: Roche, UCB, MSD, Pfizer, GSK, BMS, Lilly, Marta Elvira: None declared, Antonio Palazon Bru: None declared, Silvia Gomez-Sabater: None declared, Rocio Caño-Alameda: None declared