Evidence for Medical treatment for tertiary prophylaxis of osteoporosis

Fracture Prevention Programmes have been shown to increase both the number of patients offered bone scans and the uptake of pharmaceutical therapy, thus potentially reducing the number of further fractures. Cost-effectiveness analyses suggest that such programmes may be net cost-saving. We recommend that Fracture Prevention Programmes be developed and implemented to ensure that patients presenting with fractures are offered diagnosis and treatment for osteoporosis. Low-energy fractures are very frequent in the elderly population and are in part caused by osteoporosis. Previous fractures and low bone mineral density increase the risk of further fractures, but the available anti-osteoporosis drugs are only infrequently used in patients with recent fractures. Approximately 11-23 % of women and 3-10 % of men will suffer a hip fracture after the age of 50 years. Low-energy fractures are caused in part by osteoporosis. In Denmark, this condition affects approximately 40 % of women and 18 % of men over 50 years of age. Previous fractures and low bone mineral density increase the risk of further fractures. Among patients presenting with a hip fracture, approximately 9 % will suffer a new hip fracture within a year and approximately 20 % within 5 years. Randomized placebo-controlled trials have documented that drug treatments such as calcium plus vitamin D, oestrogen plus progestin, bisphosphonates (e.g. alendronate, risedronate, ibandronate, zoledronic acid), strontium ranelate, denosumab, teriparatide and parathyroid hormone (1-84) reduce the risk of fractures in patients with osteoporosis. Patients with recent fractures, and hip fractures in particular, are rarely offered diagnostic work-up and treatment for osteoporosis, however. Several Fracture Prevention Programmes have been tested in an attempt to overcome these problems. Studies have shown that such programs increase both the number of patients offered bone scans and the uptake of drug treatments, thus potentially reducing the number of further fractures. Cost-effectiveness analyses suggest that such programmes are likely to be net cost-saving. We recommend that Fracture Prevention Programmes be developed and implemented to ensure that patients presenting with fractures are offered diagnosis and treatment for osteoporosis. Moreover, we suggest that performance of such programmes is continuously monitored.