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Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk
Purpose To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality. Methods This observational retrospective study was based on data from administrative databases of five Italian Local H...
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| Published in: | Endocrine 2019-05, Vol.64 (2), p.367-377 |
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| container_issue | 2 |
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| container_title | Endocrine |
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| creator | Degli Esposti, Luca Girardi, Anna Saragoni, Stefania Sella, Stefania Andretta, Margherita Rossini, Maurizio Giannini, Sandro |
| description | Purpose
To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality.
Methods
This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality.
Results
A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (
N
= 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420–0.735,
p
|
| doi_str_mv | 10.1007/s12020-018-1824-9 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2150528921</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2150528921</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-8b053a0338782f323964107516eaedc9e8f35aeebcf6ab5c4989e643652200b03</originalsourceid><addsrcrecordid>eNp1kUFPHSEUhUmjqdb2B3TTkLjpZvQCjxnozmhtTUzcaNIdYXh3nujMMAXGxq2_XJ5Pa2LiBk4O3z0QDiFfGRwwgOYwMQ4cKmCqYoovKv2B7DIpdXEAtooWUlYA6s8O-ZTSDQDnvG4-kh0Bksm6Ubvk4SohDR21Y_YhZQxTiCF7R5dxXqViL6mzvfPzcHjnsx38SE9oWSabPY450X8-X9Mu2pXvfb5fK5fniOkH9cNUNA0jjVi9-E-JQ4jZPuHRp9vPZLuzfcIvz_seuTr9eXn8uzq_-HV2fHReOdHwXKkWpLAghGoU7wQXul4waCSr0eLSaVSdkBaxdV1tW-kWWmmsF6KWnAO0IPbI903uFMPfGVM2g08O-96OGOZkOJMgudKcFXT_DXoT5jiW15nyhZpLwZguFNtQLoaUInZmin6w8d4wMOuCzKYgUwoy64LMeubbc_LcDrj8P_HSSAH4BkjlaFxhfL36_dRHzFqcJg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2229253119</pqid></control><display><type>article</type><title>Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk</title><source>Springer Nature</source><creator>Degli Esposti, Luca ; Girardi, Anna ; Saragoni, Stefania ; Sella, Stefania ; Andretta, Margherita ; Rossini, Maurizio ; Giannini, Sandro</creator><creatorcontrib>Degli Esposti, Luca ; Girardi, Anna ; Saragoni, Stefania ; Sella, Stefania ; Andretta, Margherita ; Rossini, Maurizio ; Giannini, Sandro ; on the behalf of the Study group ; on the behalf of the Study group</creatorcontrib><description>Purpose
To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality.
Methods
This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality.
Results
A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (
N
= 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420–0.735,
p
< 0.001) and 64.4% lower in those receiving calcium/vitamin D supplementation compared to osteoporosis treatment only (HR = 0.356, 95% CI = 0.237-0.533,
p
< 0.001). The risk of re-fracture was 77.2% lower in treated patients who were adherent to medication (HR = 0.228, 95% CI = 0.139–0.376,
p
< 0.001). Treated patients had 64% lower mortality risk over the follow-up compared to untreated ones (HR = 0.360, 95% CI = 0.310–0.418,
p
< 0.001).
Conclusions
A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.</description><identifier>ISSN: 1355-008X</identifier><identifier>EISSN: 1559-0100</identifier><identifier>DOI: 10.1007/s12020-018-1824-9</identifier><identifier>PMID: 30515678</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged ; Aged, 80 and over ; Bone Density Conservation Agents - adverse effects ; Bone Density Conservation Agents - therapeutic use ; Calcium ; Calcium - therapeutic use ; Diabetes ; Drug therapy ; Endocrinology ; Female ; Fractures ; Health risk assessment ; Hip ; Humanities and Social Sciences ; Humans ; Internal Medicine ; Male ; Medication Adherence ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; multidisciplinary ; Original Article ; Osteoporosis ; Osteoporosis - drug therapy ; Osteoporotic Fractures - epidemiology ; Osteoporotic Fractures - mortality ; Osteoporotic Fractures - prevention & control ; Recurrence ; Retrospective Studies ; Risk ; Science ; Secondary Prevention ; Supplements ; Vertebrae ; Vitamin D ; Vitamin D - therapeutic use</subject><ispartof>Endocrine, 2019-05, Vol.64 (2), p.367-377</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>Copyright Springer Nature B.V. 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-8b053a0338782f323964107516eaedc9e8f35aeebcf6ab5c4989e643652200b03</citedby><cites>FETCH-LOGICAL-c372t-8b053a0338782f323964107516eaedc9e8f35aeebcf6ab5c4989e643652200b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30515678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Degli Esposti, Luca</creatorcontrib><creatorcontrib>Girardi, Anna</creatorcontrib><creatorcontrib>Saragoni, Stefania</creatorcontrib><creatorcontrib>Sella, Stefania</creatorcontrib><creatorcontrib>Andretta, Margherita</creatorcontrib><creatorcontrib>Rossini, Maurizio</creatorcontrib><creatorcontrib>Giannini, Sandro</creatorcontrib><creatorcontrib>on the behalf of the Study group</creatorcontrib><creatorcontrib>on the behalf of the Study group</creatorcontrib><title>Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk</title><title>Endocrine</title><addtitle>Endocrine</addtitle><addtitle>Endocrine</addtitle><description>Purpose
To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality.
Methods
This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality.
Results
A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (
N
= 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420–0.735,
p
< 0.001) and 64.4% lower in those receiving calcium/vitamin D supplementation compared to osteoporosis treatment only (HR = 0.356, 95% CI = 0.237-0.533,
p
< 0.001). The risk of re-fracture was 77.2% lower in treated patients who were adherent to medication (HR = 0.228, 95% CI = 0.139–0.376,
p
< 0.001). Treated patients had 64% lower mortality risk over the follow-up compared to untreated ones (HR = 0.360, 95% CI = 0.310–0.418,
p
< 0.001).
Conclusions
A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bone Density Conservation Agents - adverse effects</subject><subject>Bone Density Conservation Agents - therapeutic use</subject><subject>Calcium</subject><subject>Calcium - therapeutic use</subject><subject>Diabetes</subject><subject>Drug therapy</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Fractures</subject><subject>Health risk assessment</subject><subject>Hip</subject><subject>Humanities and Social Sciences</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>multidisciplinary</subject><subject>Original Article</subject><subject>Osteoporosis</subject><subject>Osteoporosis - drug therapy</subject><subject>Osteoporotic Fractures - epidemiology</subject><subject>Osteoporotic Fractures - mortality</subject><subject>Osteoporotic Fractures - prevention & control</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Science</subject><subject>Secondary Prevention</subject><subject>Supplements</subject><subject>Vertebrae</subject><subject>Vitamin D</subject><subject>Vitamin D - therapeutic use</subject><issn>1355-008X</issn><issn>1559-0100</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kUFPHSEUhUmjqdb2B3TTkLjpZvQCjxnozmhtTUzcaNIdYXh3nujMMAXGxq2_XJ5Pa2LiBk4O3z0QDiFfGRwwgOYwMQ4cKmCqYoovKv2B7DIpdXEAtooWUlYA6s8O-ZTSDQDnvG4-kh0Bksm6Ubvk4SohDR21Y_YhZQxTiCF7R5dxXqViL6mzvfPzcHjnsx38SE9oWSabPY450X8-X9Mu2pXvfb5fK5fniOkH9cNUNA0jjVi9-E-JQ4jZPuHRp9vPZLuzfcIvz_seuTr9eXn8uzq_-HV2fHReOdHwXKkWpLAghGoU7wQXul4waCSr0eLSaVSdkBaxdV1tW-kWWmmsF6KWnAO0IPbI903uFMPfGVM2g08O-96OGOZkOJMgudKcFXT_DXoT5jiW15nyhZpLwZguFNtQLoaUInZmin6w8d4wMOuCzKYgUwoy64LMeubbc_LcDrj8P_HSSAH4BkjlaFxhfL36_dRHzFqcJg</recordid><startdate>20190501</startdate><enddate>20190501</enddate><creator>Degli Esposti, Luca</creator><creator>Girardi, Anna</creator><creator>Saragoni, Stefania</creator><creator>Sella, Stefania</creator><creator>Andretta, Margherita</creator><creator>Rossini, Maurizio</creator><creator>Giannini, Sandro</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190501</creationdate><title>Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk</title><author>Degli Esposti, Luca ; Girardi, Anna ; Saragoni, Stefania ; Sella, Stefania ; Andretta, Margherita ; Rossini, Maurizio ; Giannini, Sandro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-8b053a0338782f323964107516eaedc9e8f35aeebcf6ab5c4989e643652200b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bone Density Conservation Agents - adverse effects</topic><topic>Bone Density Conservation Agents - therapeutic use</topic><topic>Calcium</topic><topic>Calcium - therapeutic use</topic><topic>Diabetes</topic><topic>Drug therapy</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Fractures</topic><topic>Health risk assessment</topic><topic>Hip</topic><topic>Humanities and Social Sciences</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>multidisciplinary</topic><topic>Original Article</topic><topic>Osteoporosis</topic><topic>Osteoporosis - drug therapy</topic><topic>Osteoporotic Fractures - epidemiology</topic><topic>Osteoporotic Fractures - mortality</topic><topic>Osteoporotic Fractures - prevention & control</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Science</topic><topic>Secondary Prevention</topic><topic>Supplements</topic><topic>Vertebrae</topic><topic>Vitamin D</topic><topic>Vitamin D - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Degli Esposti, Luca</creatorcontrib><creatorcontrib>Girardi, Anna</creatorcontrib><creatorcontrib>Saragoni, Stefania</creatorcontrib><creatorcontrib>Sella, Stefania</creatorcontrib><creatorcontrib>Andretta, Margherita</creatorcontrib><creatorcontrib>Rossini, Maurizio</creatorcontrib><creatorcontrib>Giannini, Sandro</creatorcontrib><creatorcontrib>on the behalf of the Study group</creatorcontrib><creatorcontrib>on the behalf of the Study group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Endocrine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Degli Esposti, Luca</au><au>Girardi, Anna</au><au>Saragoni, Stefania</au><au>Sella, Stefania</au><au>Andretta, Margherita</au><au>Rossini, Maurizio</au><au>Giannini, Sandro</au><aucorp>on the behalf of the Study group</aucorp><aucorp>on the behalf of the Study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk</atitle><jtitle>Endocrine</jtitle><stitle>Endocrine</stitle><addtitle>Endocrine</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>64</volume><issue>2</issue><spage>367</spage><epage>377</epage><pages>367-377</pages><issn>1355-008X</issn><eissn>1559-0100</eissn><abstract>Purpose
To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality.
Methods
This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality.
Results
A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (
N
= 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420–0.735,
p
< 0.001) and 64.4% lower in those receiving calcium/vitamin D supplementation compared to osteoporosis treatment only (HR = 0.356, 95% CI = 0.237-0.533,
p
< 0.001). The risk of re-fracture was 77.2% lower in treated patients who were adherent to medication (HR = 0.228, 95% CI = 0.139–0.376,
p
< 0.001). Treated patients had 64% lower mortality risk over the follow-up compared to untreated ones (HR = 0.360, 95% CI = 0.310–0.418,
p
< 0.001).
Conclusions
A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30515678</pmid><doi>10.1007/s12020-018-1824-9</doi><tpages>11</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Bone Density Conservation Agents - adverse effects Bone Density Conservation Agents - therapeutic use Calcium Calcium - therapeutic use Diabetes Drug therapy Endocrinology Female Fractures Health risk assessment Hip Humanities and Social Sciences Humans Internal Medicine Male Medication Adherence Medicine Medicine & Public Health Middle Aged Mortality multidisciplinary Original Article Osteoporosis Osteoporosis - drug therapy Osteoporotic Fractures - epidemiology Osteoporotic Fractures - mortality Osteoporotic Fractures - prevention & control Recurrence Retrospective Studies Risk Science Secondary Prevention Supplements Vertebrae Vitamin D Vitamin D - therapeutic use |
| title | Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk |
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