POS0097 PHARMACOLOGICAL UNDERTREATMENT OF HIP FRAGILITY FRACTURES IN THE PRIMARY CARE SETTING: A 3-YEAR PORTUGUESE NATIONWIDE PERSPECTIVE
Authors: A. Filipe, M. C. Guimarães, V. Pedrosa, B. Pinto, R. Baptista Leite
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Notwithstanding the rising prevalence of both osteoporosis and fragility fractures in developed countries, treatment of osteoporosis is still suboptimal and most patients with incident fractures will never receive appropriate pharmacological prophylaxis for subsequent fractures. <h3>Objectives:</h3> The primary objective of this study was to determine the rate of pharmacological treatment following hip fractures in the Primary Health Care (PHC) setting in Portugal from 2020 to 2022, and compare it to the period from 2018 to 2020; the secondary objective was to characterize the prescription pattern of anti-osteoporotic drugs in this context. <h3>Methods:</h3> We conducted an observational, cross-sectional, retrospective study using data from the PHC database Bilhete de Identidade - Cuidados de Saúde Primários (BI-CSP). BI-CSP is a national primary care database (except the islands of Madeira and the Azores) presenting information on demographics, health indicators, drug prescription and primary care units' management and organization. Grouped and anonymized data on any pre-specified variable over a period of time can be obtained through the application of filters. The classification tool used is the International Classification of Primary Care, 2nd Edition. We included in our study all individuals registered in the PHC in Portugal who sustained a hip fracture after the age of 50 years. Treatment rates were determined after considering any prescription of an anti-osteoporotic drug to these patients in the PHC, from 2020 to 2022. The results were compared with data from 2018 to 2020. The frequency of prescription for each type of drug was also assessed. All outcomes of interest were extracted to a data extraction sheet created for this purpose. Descriptive statistics were generated using Microsoft Office ExcelⓇ 2016. This study was approved by the local ethics committee. <h3>Results:</h3> We identified a total of 48.532 hip fractures in Portugal between 2020 and 2022, 36.384 (74.9%) in female patients. Most hip fractures were recorded in the North- (19076) and Lisbon- (15559) Regional Health Administrations (RHA). Only 7391 (15.2%) patients were treated with anti-osteoporotic therapies following hip fracture, which represents a slight improvement compared to 2018-2020 (6282, 14%). The RHA with the highest treatment rate was the Algarve (17.6%) and the lowest was Alentejo (12.2%). National and regional prescription patterns are shown in Table 1. Bisphosphonates were the most frequently used therapies, particularly alendronic acid (58.1%), ibandronic acid (18.1%) and zoledronic acid (8%), although a decline from 2020 was observed. On the opposite side, denosumab prescription doubled from 5.1% (2018-2020) to 11.9% (2020-2022) (Figure 1). <h3>Conclusion:</h3> Only a minority of patients (15.2%) received anti-osteoporotic treatment following hip fractures in the PHC setting in Portugal. The most frequently used therapies were bisphosphonates, namely alendronic acid, but denosumab prescription doubled between 2018-2020 and 2020-2022. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Araujo Filipe MSD, Abbvie, MSD, Abbvie, Medac, Bial, Amgen, Pfizer, Biogen, Novartis, Lilly and Atral., Pfizer, Mariana C. Guimarães: None declared, Vítor Pedrosa: None declared, Beatriz Pinto: None declared, Raquel Baptista Leite: None declared.