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Treatment of high fracture risk patients in routine clinical practice

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Abstract

Summary

A retrospective cohort study determined the high incidence of recurrent fractures in osteoporotic patients with high fracture risk during the observation. The strategy of starting treatment with more potent regimens (zoledronic acid, denosumab and/or teriparatide) seems to have the best secondary fracture prevention efficacy.

Objective

This paper describes the various medical therapy regimens prescribed to osteoporotic patients with high fracture risk and the result of treatment.

Methods

We carried out a retrospective cohort study in selected Osteoporosis Centers. Patients were considered to have high fracture risk in case of a history of a low-energy hip fracture or two or more vertebral or other site fractures. A total of 812 subjects (768 women and 44 men) aged 36–95 years were included. The observation period was 2285.1 patient-years. Demographic data, clinical findings, and BMD data obtained by DXA, as well as a history of fractures that had occurred during the follow-up, were included in the analysis.

Results

Overall, at baseline, there were 637 non-vertebral fractures including 104 hip fractures. A total of 590 patients had vertebral fractures; of these, 69% suffered multiple fractures. Being on treatment, 119 (14.7%) patients developed new vertebral and non-vertebral fractures. The incidence of new non-vertebral fractures and hip fractures was 39.4 and 13.1 per 1000 patient-years. The total number of vertebral fractures increased by 24.8% from 1353 to 1689. The best results of the treatment were achieved in patients who were started on zoledronic acid, denosumab, or teriparatide and had an adequate duration of treatment. Although these patients had significantly lower BMD values at the time of diagnosis compared with other patients, they showed a lower incidence of new vertebral and hip fractures, during the follow-up.

Conclusion

Therapy of patients at high risk of fractures started with more potent treatment regimens (zoledronic acid, denosumab and/or teriparatide) of adequate duration was more effective in terms of prevention of new vertebral and hip fractures as compared with other treatment options. However, treatment appears to be challenging given the number of recurrent fractures in patients on treatment and the frequency of drug withdrawal or replacement.

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Funding

The study was conducted with the financial support from Eli Lilly and Company, Indianapolis, Indiana, USA. This included technical support in communication, coordination of the study centers, and translation of the manuscript.

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Authors and Affiliations

  1. North West State Medical University named after I.I.Mechnikov, St. Petersburg, Russia

    Olga Lesnyak, Elena Gladkova & Rusanna Samigullina

  2. Saint-Petersburg Municipal Clinical Rheumatology Hospital No. 25, St. Petersburg, Russia

    Olga Lesnyak & Elena Gladkova

  3. Lilly Pharma LLC, Moscow, Russia

    Nikolay Aleksandrov & Diana Priymak

  4. National Medical Research Center of Endocrinology, Moscow, Russia

    Zhanna Belaya, Tatiana Grebennikova & Ludmila Rozhinskaya

  5. Yaroslavl State Medical University, Yaroslavl, Russia

    Ksenia Belova & Olga Ershova

  6. Federal Center of Traumatology, Orthopedics and Endoprosthesis Replacement, Cheboksary, Russia

    Natalya Bezlyudnaya

  7. Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russia

    Olga Dobrovolskaya & Natalya Toroptsova

  8. Moscow Regional Research and Clinical Institute named after M.F. Vladimirsky, Moscow, Russia

    Alexandr Dreval & Irina Kryukova

  9. St Petersburg State University, St. Petersburg, Russia

    Sergey Mazurenko

  10. Ural State Medical University, Yekaterinburg, Russia

    Alexander Solodovnikov

Authors
  1. Olga Lesnyak
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  2. Elena Gladkova
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  14. Ludmila Rozhinskaya
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  15. Rusanna Samigullina
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  16. Alexander Solodovnikov
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  17. Natalya Toroptsova
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Corresponding author

Correspondence to Olga Lesnyak.

Ethics declarations

All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or compatible ethical standards.

Conflicts of interest

Olga Lesnyak, Elena Gladkova, Zhanna Belaya, Ksenia Belova, Natalya Bezlyudnaya, Olga Dobrovolskaya, Alexandr Dreval, Olga Ershova, Tatiana Grebennikova, Irina Kryukova, Sergey Mazurenko,, Ludmila Rozhinskaya, Rusanna Samigullina, Alexander Solodovnikov, and Natalya Toroptsova declare that they have no conflict of interest. Nikolay Aleksandrov and Diana Priymak are employees of Eli Lilly and Company and own stocks.

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Lesnyak, O., Gladkova, E., Aleksandrov, N. et al. Treatment of high fracture risk patients in routine clinical practice. Arch Osteoporos 15, 184 (2020). https://doi.org/10.1007/s11657-020-00851-z

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