Compliance reduces, does not eliminate refracture risk in Asians
Adherence to treatment reduces but does not eliminate the risk of refracture in Asian patients with osteoporosis, according to a presentation at the 6th Asia-Pacific Osteoporosis Meeting (IOF Regionals 2016) held in Singapore.
“Risk of subsequent fracture remains despite good adherence to treatment,” said Professor Sarath Lekamwasam from the Population Health Research Centre at the University of Ruhuna in Galle, Sri Lanka. [IOF Regionals 2016, abstract PL 12]
A study from South Korea demonstrated that the incidence of a subsequent hip fracture was 5.1 percent at 2 years and 8.6 percent at 8 years after the initial fracture, though compliance with biphosphonate therapy reduced the risk of refracture (4.2 percent vs 10.9 percent in compliant vs noncompliant individuals, respectively; p=0.001). [Osteoporos Int 2013;24:2099-2104]
In Taiwan, a study indicated that refracture rates in osteoporosis patients increased with time, with 5.15, 7.36, and 8.49 percent experiencing a refracture 1, 2, and 3 years after the initial fracture. Researchers attributed this elevated risk to poor compliance with biphosphonate therapy, as well as to age and comorbidities such as diabetes mellitus and dementia. [Osteoporos Int 2013;24:511-521]
A study in Japan found a high risk of refracture within 3 years of the initial fracture (85.7 percent). Dementia (hazard ratio [HR], 1.87, 95 percent confidence interval [CI], 1.02–3.41; p=0.042) and respiratory disease (HR, 4.41, 95 percent CI, 2.33–8.34; p<0.001) were associated with refracture incidence. [J Orthop Sci 2010;15:192-197]
Another study in Taiwan showed that individuals with a prior hip fracture had a 9.18 percent risk of refracture, with age, female gender, obesity, diabetes, arterial hypertension, hyperlipidaemia, stroke, blindness, and long-term analgesic and anti-inflammatory medication use increasing the risk. On the other hand, biphosphonate therapy after hip surgery reduced the risk. [J Am Med Dir Assoc 2014;15:725-731]
Despite these studies, limited data exists with regards to the risk of refracture in Asians, with a particular lack of studies in the South Asian region, said Lekamwasam.
“We know there is a huge care gap in osteoporosis treatment [and] we have a reasonable suspicion that the care gap in Asia is wider,” said Lekamwasam. Lack of awareness on the part of both the patient and physician, failure to screen and offer specific treatment, and poor adherence to osteoporosis therapy are just some of the potential factors causing the care gap, he said.
“Medical professionals should be educated to acknowledge the high fracture risk associated with the first fragility fracture and the necessity to offer appropriate care for such patients regardless of BMD estimation or risk categorization.”