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Characterisation of Patients with Postmenopausal Osteoporosis in French Primary Healthcare

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Abstract

Background

The public health burden of osteoporosis is high, principally because of increased risk of fractures and associated morbidity, handicap and mortality. Osteoporotic fracture prevention is therefore an important public health goal. General practitioners (GPs) play a key role in the management of osteoporosis, both in ensuring timely diagnosis and in providing treatment. Little information is available on standards of care for postmenopausal women with osteoporosis in general practice.

Objectives

The primary objective of this study was to describe risk factors and treatment in postmenopausal women with osteoporosis. Secondary objectives were to evaluate treatment compliance and to assess the impact of osteoporosis on quality of life.

Methods

This observational, cross-sectional, pharmacoepidemiological study was performed in a primary-care setting in France. A random sample of GPs recruited postmenopausal women with a diagnosis of osteoporosis who had been followed by the investigator for at least 2 years. At inclusion, investigators completed a questionnaire providing information on patient age, osteoporosis duration, risk factors and treatment history. The first three patients recruited by each investigator completed a questionnaire providing information on sociodemographic features, osteoporosis treatments and quality of life. Treatment compliance was quantified using the Test d’Evaluation de l’Observance and quality of life evaluated using the 12-item Short Form Health Survey (SF-12).

Results

Overall, 389 physicians included 3097 patients, of whom 1053 completed the patient questionnaire. Risk factors for osteoporotic fracture were identified in 2148 patients (69.4%), most frequently personal or maternal antecedents of osteoporotic fracture and a low body mass index. Of these, 946 (44.0%) presented more than one risk factor. At the time of diagnosis, 629 patients (59.7%) presented fractures, which involved the vertebrae in 51.7% of cases, the wrist in 40.5% and the hip in 5.4%. Older patients were more likely to have fractures at the time of diagnosis and to have multiple fractures. After diagnosis, at least one new fracture occurred in 201 patients (19.2%). Multivariate logistic regression analysis identified age >70 years, diagnosis at least 10 years previously, diagnosis based on the presence of a fracture, biochemical and haematological evaluation at the time of diagnosis, and a change in osteoporosis treatment in the previous 2 years as being significantly associated with incident fracture risk. At inclusion, 1019 patients (97.4%) were receiving treatment for osteoporosis, most frequently weekly bisphosphonates (71.6% of treatments). Most patients (81.0%) had been treated for at least 1 year. Treatment compliance was high in 61% of patients and low in <5%. Patient variables associated with high compliance were being retired, prescription of bisphosphonates and, among the bisphosphonate users, prescription of weekly formulations. SF-12 quality-of-life scores were low, ranging from 38.6 (energy/vitality) to 65.1 (social functioning) out of a possible maximum score of 100. Baseline variables associated with SF-12 physical component summary scores included age, height loss since menopause, diagnosis following a fracture, fracture incidence since diagnosis, time since diagnosis and treatment with bisphosphonates.

Conclusions

In this study of postmenopausal osteoporosis in the French primary healthcare setting, many women with osteoporosis were diagnosed following a fracture. Although most were treated with bone-consolidating drugs, compliance was suboptimal in a significant minority. Osteoporotic fracture was associated with reduced quality of life.

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Acknowledgements

This study was funded by Laboratoires GlaxoSmithKline and Laboratoires Roche. The sponsors initiated the study, supervised its conduct and organised the preparation of the manuscript. Operational responsibility for the study was delegated to a contract research organisation (Nukleus) and data management and statistical analysis were performed by Cenbiotech. The academic authors (F. Blotman, B. Cortet, P. Hilliquin, B. Avouac, F.-A. Allaert and D. Pouchain) formed the scientific advisory board for the study and advised on the design of the protocol and the interpretation of the results. All received consultancy fees for their participation in the study. F.-A. Allaert is employed by Cenbiotech, who performed the data analysis. A.-F. Gaudin, F.-E. Cotté and A. El Hasnaoui are employees of Laboratoires GlaxoSmithKline.

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Authors and Affiliations

  1. Rheumatology Department, Montpellier University Hospital, Montpellier, France

    Francis Blotman

  2. Rheumatology Department, Hôpital Roger Salengro, Lille, France

    Bernard Cortet

  3. Rheumatology Department, Sud Francilien Hospital, Corbeil-Essonne, France

    Pascal Hilliquin

  4. OFOS (Observatoire Français pour l’Ostéoporose), Paris, France

    Bernard Avouac

  5. Biostatistics Department, Cenbiotech, Regional University Hospital, Dijon, France

    François-André Allaert

  6. General Practice Department, UFR Créteil, Créteil, France

    Denis Pouchain

  7. GlaxoSmithKline Laboratory, 100 Route de Versailles, 78 163, Marly-le-Roi Cedex, France

    Anne-Françoise Gaudin,  François-Emery Cotté & Abdelkader El Hasnaoui

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  1. Francis Blotman
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  2. Bernard Cortet
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  3. Pascal Hilliquin
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  9. Abdelkader El Hasnaoui
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Correspondence to François-Emery Cotté.

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Blotman, F., Cortet, B., Hilliquin, P. et al. Characterisation of Patients with Postmenopausal Osteoporosis in French Primary Healthcare. Drugs Aging 24, 603–614 (2007). https://doi.org/10.2165/00002512-200724070-00007

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