title: Low prevalence of osteoporosis treatment in patients with recurrent major osteoporotic fracture.
abstract: The majority of patients do not receive anti-osteoporotic treatment following a major osteoporotic fracture, despite the guidelines and the availability of effective anti-osteoporotic treatments. The fight against factors limiting the diagnosis and treatment of osteoporosis should become a priority to improve secondary prevention after an initial osteoporotic fracture.
  
  
  OBJECTIVE
  Despite the availability of effective anti-osteoporotic treatments, osteoporosis management is currently insufficient. The main objective of this study was to assess the prevalence of anti-osteoporotic treatments introduced after an initial prior major osteoporotic fracture during hospitalization for recurring fractures.
  
  
  METHODS
  We conducted an observational, cross-sectional, bicentric study that included all patients aged over 50 years who were hospitalized or seen in consultation for major osteoporotic fracture.
  
  
  RESULTS
  One hundred twenty-eight out of two hundred four (62.7%) patients had a past history of major osteoporotic fracture and therefore had an indication of treatment based on guidelines. Among these patients, only 43/128 (33.5%) had received anti-osteoporotic treatment as secondary prevention after the initial fracture. The main causes of non-prescription identified were the attending physicians' ignorance of the indication of treatment (n = 30; 35.3%), ignorance of the fracture (n = 17; 20%), and comorbidities (n = 12; 14.1%). The failure to introduce treatment was associated with the presence of comorbidities with a Charlson Comorbidity Index ≥6 (OR = 0.34 [0.16-0.73], p < 0.05), dementia (OR = 0.23 [0.08-0.72], p < 0.05), and past history of proximal femur fracture (OR = 0.20 [0.04-0.91], p < 0.05).
  
  
  CONCLUSIONS
  Two thirds of patients with a past history of major osteoporotic fracture presenting with a new fracture were not treated. The main reason for lack of treatment seems to stem from the incorrect assessment of the patient's fracture risk. Although major osteoporotic fracture leads to an increased risk of mortality and requires treatment, the significance of patient comorbidities was an independent risk factor leading to non-treatment.
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, 16, B.D de Bulgarie, 35 203, Rennes, France. jeremyflais@gmail.com.|Université de Rennes 1, 35 043, Rennes, France. jeremyflais@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Flais
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, 16, B.D de Bulgarie, 35 203, Rennes, France.|Université de Rennes 1, 35 043, Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Coiffier
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Régional de Lorient, 56 322, Lorient, France.
authors.forename: J
authors.initials: J
authors.lastname: Le Noach
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, 16, B.D de Bulgarie, 35 203, Rennes, France.|Université de Rennes 1, 35 043, Rennes, France.
authors.forename: J D
authors.initials: JD
authors.lastname: Albert
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, 16, B.D de Bulgarie, 35 203, Rennes, France.|Université de Rennes 1, 35 043, Rennes, France.
authors.forename: M
authors.initials: M
authors.lastname: Faccin
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, 16, B.D de Bulgarie, 35 203, Rennes, France.|Université de Rennes 1, 35 043, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Perdriger
authors.affiliation: Université de Rennes 1, 35 043, Rennes, France.|Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 35 043, Rennes, France.
authors.forename: H
authors.initials: H
authors.lastname: Thomazeau
authors.affiliation: Service de Rhumatologie, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, 16, B.D de Bulgarie, 35 203, Rennes, France.|Université de Rennes 1, 35 043, Rennes, France.|INSERM UMR 991, 35 000, Rennes, France.
authors.forename: P
authors.initials: P
authors.lastname: Guggenbuhl
mesh_terms: D000368:Aged; D018890:Chemoprevention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Major fracture; Obstacles to treatment; Osteoporosis; Secondary prevention