Two-year adherence to treatment and associated factors in a fracture liaison service in Spain
- 414 Downloads
A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture.
The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures.
Fragility fractures in patients over 50 attending the emergency room in our centre are captured by the recruitment system of a secondary prevention program. The unit is attended by a nurse, coordinated by two rheumatologists and with the collaboration of primary care consisted of a training program and annual meetings. The outcome of the program was analysed 2 years after implementation, including: (1) percentage of attendees/eligible; (2) percentage of attendees who start treatment with antiresorptive; (3) percentage of patients who retain treatment after 6, 12, 18 and 24 months; and (4) factors associated to adherence.
After 2 years of implementation, the program detected 1674 patients with fracture, of whom 759 finally entered the program (57 % of eligible). After 3 months, 82 % of patients prescribed an antiresorptive started treatment. After a year, 52 % of the patients in the program, 72 % of those of a prescribed treatment, were taking antiresorptives. Adherence at 24 months among those who had prescribed anti-fracture drugs was 73 %. Factors associated with adherence at 12 months were female sex (76 vs 45 %; p = 0.01) and previous treatment with antiresorptive (86 vs 68 %; p = 0.02).
In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term.
KeywordsAdherence Bisphosphonates Fracture liaison service Fragility fracture Osteoporosis Secondary prevention Training program
Authors give thanks to Carmen Alonso, Fabiola Santana, and Ruben Lopez (Rheumatology), Sinforiano Rodriguez (Geriatry), and Manuel de la Torre (Orthopaedics), Hospital Universitario de Gran Canaria Dr. Negrin, for their collaboration and to Loreto Carmona for revising the manuscript.
Conflicts of interest
Proyecto nacional del Ministerio de Ciencia e Innovación. Instituto de Salud Carlos III: PI11/01429
- 1.Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8Google Scholar
- 12.Drew S, Sheard S, Chana J, Cooper C, Javaid MK, Judge A, REFReSH study group (2014) Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England. Osteoporos Int 25:2427–2433PubMedCentralCrossRefPubMedGoogle Scholar
- 22.Naranjo A, Ojeda-Bruno S, Bilbao Cantarero A, Quevedo Abeledo JC, Henriquez-Hernandez LA, Rodriguez-Lozano C (2014) Results of a model of secondary prevention for osteoporotic fracture coordinated by rheumatology and focused on the nurse and primary care physicians. Reumatol Clin 10:299–303CrossRefPubMedGoogle Scholar
- 27.National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. In: National Osteoporosis Foundation, ed. Washington, DC; 2010.Google Scholar
- 32.Ganda K, Schaffer A, Pearson S, Seibel MJ (2014) Compliance and persistence to oral bisphosphonate therapy following initiation within a secondary fracture prevention program: a randomised controlled trial of specialist vs. non-specialist management. Osteoporos Int 25:1345–1355CrossRefPubMedGoogle Scholar