POS0167 SECONDARY PREVENTION OF VERTEBRAL FRACTURES IN REAL PRACTICE
Authors: J. E. Oller Rodríguez, E. Grau García, S. Leal Rodriguez, M. E. Acosta, C. Riesco Barcena, A. V. Huaylla Quispe, C. Pávez Perales, M. De la Rubia Navarro, I. Martínez Cordellat, C. Nájera Herranz, R. Negueroles Albuixech, F. M. Ortiz Sanjuan, E. Vicens Bernabeu, C. Alcañiz Escandell, I. Cánovas Olmos, I. Chalmeta Verdejo, J. J. Fragío Gil, L. Gonzalez Puig, J. Ivorra Cortés, J. A. Román Ivorra
Journal: Annals of the Rheumatic Diseases (2021)

Background: Vertebral fractures increases the risk of new fractures and deaths. There are different antiresorptive medications to prevent a secondary fracture, as bisphosphonates, teriparatide or denosumab, but little is known about the effects of secondary fracture appearance in real life. Objectives: To evaluate the appearance of new vertebral fractures depending on the treatment used for secondary prevention. Methods: We conducted a prospective descriptive study of patients with a first diagnosis of vertebral fracture from 2010 to 2017 and assessed the subsequent finding of new fractures. We selected patients with at least 3 years of secondary prevention with antiresorptive drugs or with sequential treatment (anabolic followed by, at least, 1 year with antiresorptive drugs), and excluded those who experienced new fractures within the first 6 months of treatment. Results: A total of 400 patients were selected from an initial base of 1018 patients. The average age of onset of the first fracture was 69.7 years, 84% of female patients and 16% of female patients. 38.5% suffered dorsal fractures, 33.75% lumbar fractures and 27.75% dorsolumbar fractures. We classified the secondary prevention strategies according to the different therapeutic options, as we can see in Table 1. We analysed the association between the appearance of new vertebral fracture corrected by sex with the age of the initial fracture its location. No association was found. We also performed a multivariate Bayesian model of logistic regression, in order to analyze the association between the appearance of new vertebral fracture and factors as the age of the initial fracture, its sex and the pharmacologic option used as secondary prevention. No statistically significant differences were observed between the different antiresorptive treatments and their efficacy as a secondary prevention of vertebral fractures. However, there was a tendency for a smaller occurrence of new fractures in patients undergoing sequential treatment. On the other hand, similar results were observed between denosumab and oral bisphosphonates, observing somewhat worse data with zoledronate (figure 1), probably due to patients under zoledronate treatment showed high osteoporotic risk and worse prognosis. Pharmacologic option Patients (%) New fractures (%) Denosumab 192 (48%) 10 (5.21%) Teriparatide (up to 2 years) + Denosumab (at least 1 year) 86 (21.5%) 0 (0%) Oral bisphosphonate (alendronate, risedronate or ibandronate) 58 (14.5%) 3 (5.17%) Zoledronate 33 (8.25%) 4 (12.12%) Teriparatide (up to 2 years) + oral bisphosphonate (at least 1 year) 28 (7%) 2 (7.14%) Teriparatide (up to 2 years) + Zoledronate (at least 1 year) 3 (0,75%) 0 (0%). Conclusion: No differences between the different secondary prevention options in terms of the appearance of new fractures were observed. Disclosure of Interests: None declared