title: Two-year adherence to treatment and associated factors in a fracture liaison service in Spain.
abstract: A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture.
  
  
  BACKGROUND
  The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain. anaranjoh@yahoo.es.|Medical and Surgical Sciences Department, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. anaranjoh@yahoo.es.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-2013-6664
authors.initials: A
authors.lastname: Naranjo
authors.affiliation: Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Ojeda-Bruno
authors.affiliation: Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Bilbao-Cantarero
authors.affiliation: Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Quevedo-Abeledo
authors.affiliation: Primary Care Service, Gerencia de Atención Primaria de Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors.forename: B V
authors.initials: BV
authors.lastname: Diaz-González
authors.affiliation: Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez-Lozano
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D012307:Risk Factors; D055502:Secondary Prevention / Q000458:organization & administration; D012737:Sex Factors; D013030:Spain; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Adherence; Bisphosphonates; Fracture liaison service; Fragility fracture; Osteoporosis; Secondary prevention; Training program