We present three analyses relating to Secondary Fracture Prevention programs (SFPP) that have been instituted to address the gap in osteoporosis management: (1) Systematic review and meta-analysis of 42 publications on SFPPs published between 1996 and 2011: Outcome measures extracted included bone mineral density (BMD) testing and osteoporosis treatment initiation rates. Studies were grouped into 4 models from Type A (assessment & treatment) through to type D (patient education only). Meta-analyses demonstrated increased BMD testing (p=0.06) and treatment initiation rates (p=0.03) with increasing intervention intensity. (2) A 2-year RCT of 102 patients initiated on oral bisphosphonate therapy at a SFPP, randomised to 6-monthly follow-up with the SFPP (Group A) or primary care physician follow-up (Group B). Compliance & persistence were measured using claims data and their predictors analysed. At 24-months, medication possession ratio (MPR) and persistence were high and similar in both groups. In the adjusted analysis, patients in group A were not more likely to be compliant or persistent than those in group B, indicating that initiation of therapy within an SFPP is associated with high long-term therapeutic adherence. (3) In a 7-year prospective study, we determined predictors of re-fracture amongst 234 subjects managed by the Concord SFPP. In multivariate analysis, co-morbidity (HR 2.04 if >3, 95%CI 1.10-3.79), corticosteroid use (HR 1.75, 1.12-2.73), total hip BMD (HR 1.36 per 0.1g/cm2 decrease, 1.08-1.70) and a MPR of <50% (HR 3.36, 1.32-8.53) were significantly associated with re-fracture, indicating patients with these criteria are at high re-fracture risk, requiring intensive management. Our results demonstrate that (a) intensive SFPPs (Type A) are effective in raising treatment rates; (b) following treatment initiation by the programme, patients are likely to adhere to therapy outside the SFPP; and (c) therapeutic compliance remains the major determinant of re-fracture.
Disclosure: The authors declared no competing interests. This work was supported by the ANZAC Research Institute, Sydney, Australia.