ECTS Abstracts (2015) 1 P344

Closing the gap in osteoporosis management: implementation and outcome analysis of secondary fracture prevention programs

Kirtan Ganda1,2 & Markus Seibel1,2

1ANZAC Research Institute, University of Sydney, Sydney, Australia; 2Department of Endocrinology and Metabolism, Concord Hospital, Sydney, Australia.

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.

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