We studied effectiveness of osteoporosis treatment in women older than 80 years, who often are not included in clinical trials. Treatments were as effective on bone density and fractures as in younger women. To study real-world effectiveness of osteoporosis treatment on BMD and fractures in the oldest old women (≥ 80 years) compared with women (60–79 years) in the clinical setting using Swedish health register data. National registers and data from DXA machines were used to study effectiveness of all available osteoporosis treatments in women 60–79 and ≥ 80 years using three approaches: (1) Total Hip BMD change up to 8 years after treatment start; (2) fracture incidence where patients served as their own controls, comparing the first 3 months after treatment start with the subsequent 12 months; and (3) comparison of fracture incidence post-fracture in women ≥ 80 years treated with osteoporosis treatment or calcium/vitamin D. Analysis 1: Total Hip BMD increased by up to 6.7% and 7.7% in women 60–79 and ≥ 80 years old, respectively. The mean increase in BMD was 1.1%-units per year in both age groups. Analysis 2: Relative to the 3-month baseline, fracture incidence decreased during the subsequent 12 months of treatment. Incidence rate ratios were estimated at 0.65, 0.74, 0.29, and 0.81 for any, hip, vertebral, and non-hip-non-vertebral fracture, respectively. Analysis 3: A 24-month incidence of any fracture in women ≥ 80 years given post-fracture osteoporosis treatment was lower (HR = 0.78) than in women given calcium/vitamin D, but treatment allocation was not random, with lower mortality (HR = 0.51) in patients receiving OP treatment. Osteoporosis medication in women > 80 years in clinical practice likely works, and the magnitude of effect is similar to what was estimated in younger women. The choice between osteoporosis treatment and calcium/vitamin D after fracture in women ≥ 80 years is not random but appears associated with the patient’s health status and presence of vertebral fractures, rather than the known risk profile of sustaining a fracture at a high age.

This study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures. This study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures. Retrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis. Two hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9–7.2) and at 24 months was 12.0% (95% CI, 11.8–12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80–89 years [reference 50–59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months). Our findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

The vitamin D receptor (VDR) has been proposed as a candidate gene for several musculoskeletal phenotypes. However, previous results on the associations between genetic variants of the VDR with muscle strength and falls have been contradictory. The MrOS Sweden survey, a prospective population-based cohort study of 3014 elderly men (mean age 75 years, range 69-81) offered the opportunity to further investigate these associations. At baseline, data were collected on muscle strength and also the prevalence of falls during the previous 12 months. Genetic association analysis was performed for 7 Single Nucleotide Polymorphisms (SNPs), covering the genetic region surrounding the VDR gene in 2924 men with available samples of DNA. Genetic variations in the VDR were not associated with five different measurements of muscle strength or physical performance (hand grip strength right and left, 6 m walking test (easy and narrow) and timed-stands test). However, one of the 7 SNPs of the gene for the VDR receptor, rs7136534, was associated with prevalence of falls (33.6% of the AA, 14.6% of the AG and 16.5% of the GG allele). In conclusion, VDR genetic variants are not related to muscle strength or physical performance in elderly Swedish men. The role of the rs7136534 SNP for the occurrence of falls is not clear.

Background In Sweden, ∼50% of women and ∼25% of men are expected to suffer an osteoporosis (OP)-related fracture (Fx) during their lifetime, and hip Fx incidence in Sweden is one of the highest worldwide. Despite this, nationally only 12% of patients with Fx are prescribed an OP treatment following Fx.1 Understanding the reasons for the marked under-treatment of patients with Fx may provide insights into how to improve deficiencies in the management of OP. Objectives To assess rates of OP treatment initiation within 1 year (<1 yr) following first Fx in treatment-naïve patients with fracture in Sweden and to evaluate the determinants of treatment initiation. Methods Patients aged ≥50 yrs with any type of Fx were identified from Swedish national registers between 2006–2012 and followed from time of first Fx. Patients who were treatment-naïve at the time of first Fx were included in the analysis. Here, we report OP treatment initiation <1 yr after Fx in the different baseline subgroups considering gender, age, Fx type, steroid use and comorbidities. Results 258,827 treatment-naïve patients with a first Fx (68% female; mean age 72.7 [SD 12.9] yrs) were included. Overall, 6.6% of patients initiated OP treatment <1 yr; the proportion was higher in females (8.5%) than in males (2.3%), and was highest in patients aged 70–80 yrs (10.7%) vs other ten-year age groups (mean 5.5%). Patients with a diagnosed vertebral Fx were more likely to start OP treatment (21.2%) compared with non-vertebral Fx (5.6%). The proportion of patients starting OP treatment was higher in patients receiving glucocorticoid (GC) treatment (17%) compared with those not treated with glucocorticoids (6.1%). In general, comorbidities were not positively associated with treatment initiation, except for those indirectly connected to known contributors of Fx risk, i.e. chronic pulmonary disease (GC use) and rheumatoid arthritis (FRAX-algorithm risk factor), which were associated with increased treatment initiation. Although both dementia and dependency are known to be associated with increased risk of Fx, the tendency to initiate treatment was lower in patients with these conditions compared with those without (1.5% vs 6.9% and 2.3% vs 7.4%, respectively). Conclusions This study confirms the large treatment gap in OP treatment initiation following a first Fx in Sweden; rate of OP treatment initiation was below the post-Fx treatment initiation rate goal of 30% and also lower than the 12% published national indicator for treatment exposure (2015).1 The proportion of patients initiating OP treatment appears to be somewhat influenced by gender, age, Fx type, GC use, rheumatic disease, dependency and dementia; nevertheless, treatment initiation rates were low. These data highlight the need for significant efforts to improve OP management post Fx in Sweden. References Swedish Association of Local Authorities and Regions (SKL) and The National Board of Health and Welfare (2015) Öppna Jämförelser 2015, Hälso- och sjukvård vid kroniska sjukdomar. Acknowledgements Funded by UCB Pharma. Disclosure of Interest A. Spångéus Consultant for: Amgen, Speakers bureau: Amgen; Eli Lilly, K. Åkesson Grant/research support from: Amgen, Eli Lilly, Ö. Ljunggren Grant/research support from: Amgen, Eli Lilly, J. Banefelt Consultant for: Quantify Research, funded by UCB to conduct this study, Employee of: Quantify Research, funded by UCB to conduct this study, L. Karlsson Consultant for: Quantify Research, funded by UCB to conduct this study, Employee of: Quantify Research, funded by UCB to conduct this study, G. Ortsäter Consultant for: Quantify Research, funded by UCB to conduct this study, Employee of: Quantify Research, funded by UCB to conduct this study, C. Libanati Shareholder of: UCB Pharma, Employee of: UCB Pharma, E. Toth Shareholder of: UCB Pharma, Employee of: UCB Pharma, O. Ström Grant/research support from: Quantify Research, funded by UCB to conduct this study, Consultant for: Quantify Research, funded by UCB to conduct this study

Fracture is an established risk factor for future fracture and important for risk-assessment, economic modelling, and treatment decision-making. We estimated the risk of subsequent MOF following first, second and third fracture. Women ≥50 years with ≥1 fracture between 2006-2012 (index date) were identified from national registers (1998–2015) and followed from first, second and third fracture. Women with a fracture at index were matched (1:3) with non-fracture controls, based on gender and age. Fracture risk was assessed by a parametric survival spline model with subsequent MOF as failure event, and controlled for nine known risk factors (comorbidities, treatment, demographic-related). 229,259 women (agemean=74 years) with one fracture, 36,465 (agemean=80 years) with two and 6,687 (agemean=83 years) with three were identified. Five-year cumulative incidence of subsequent MOF was 23.0% (CI95:22.7–23.4) after first fracture (index any site), 37.6% (CI95:36.1–39.1) after second, 21.2% (CI95:18.0–25.0) after third, with the majority of subsequent fractures occurring in the first 2 years post fracture. Risk of subsequent MOF was highest in the first 6 months following index fracture; the adjusted relative risk (RR) of MOF was 2.2 (CI95:2.1–2.2) following any fragility fracture, 4.5 (CI95:4.2–4.9) following a vertebral fracture and 1.9 (CI95:1.8–2.1) following a hip fracture. After a second fracture, these RRs were 2.6 (CI95:2.4–2.8), 3.8 (CI95:2.9–5.2) and 2.0 (CI95:1.9–2.1); and after the third fracture, the RR was 1.5 (CI95:1.5–1.5). Fracture risk significantly increases rapidly within 6 months following a fragility fracture, remains very elevated in the subsequent 2 years and persists over 5 years. The relative risk manifests within 6 months and gradually declines over 5 years following the fracture. A patient who has suffered any fragility fracture requires prompt intervention to minimize that risk and avoid significant personal, economic and societal burden.

Short-Term Fracture (Fx) Incidence And Risk Factors Following Fracture In A Swedish Database Study

The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings.

L’étude observationnelle européenne Forsteo a évalué l’incidence des fractures, des maux de dos, de la qualité de vie (QV) et de la persistance du traitement chez les femmes post-ménopausées traitées par du tériparatide en routine dans 8 pays européens. Nous présentons les résultats pour la France, où les critères de remboursement du tériparatide par l’assurance maladie sont réservés aux femmes ayant une maladie sévère et avec traitement limité à 18 mois.Un échantillon représentatif de femmes débutant un traitement par du tériparatide en France a été suivi en routine pendant 36 mois. Nous avons pris en compte les caractéristiques des patientes à l’inclusion, la prise en continu de tériparatide (Kaplan-Meier analyse), l’incidence des fractures, des maux de dos, et la qualité de vie (EQ-5D) à l’inclusion, puis après 18 et 36 mois de suivi (dernière observation reportée).Cent seize rhumatologues ont inclus 309 patients, dont 290 (93,9 %) ont eu au moins une visite de suivi. L’âge moyen des femmes (écart-type) était de 74,5 (7,4) ans et 296 (95,8 %) avaient eu au moins 2 fractures vertébrales avant traitement par tériparatide. L’incidence des fractures cliniques, principalement vertébrales, diminuait 6 mois environ après le début du traitement par tériparatide, et duraient jusqu’à 36 mois (p = 0,013). La plupart des patients étaient traités par antirésorptifs. Les maux de dos et les mesures EQ-5D étaient améliorés de façon significative à 18 et 36 mois (p < 0,0001) dans les analyses de DOR, mais pas l’échelle visuelle EQ-5D après ajustement de la covariable dans le modèle RMMR. La durée médiane de traitement était de 17,4 mois.Les femmes françaises débutant un traitement par tériparatide en routine avaient une ostéoporose sévère et il existait une bonne observance du traitement, en accord avec les critères de remboursement de l’assurance en France. L’amélioration du risque de fracture et des maux de dos commençait peu après le traitement et était maintenue après 36 mois de suivi.

Falls and fractures share several common risk factors. Although past falls is not included as an input variable in the FRAX calculator, we demonstrate that FRAX probability predicts risk of incident falls in the MrOs Sweden cohort.

Background: Osteogenesis imperfecta (OI) is an inherited heterogeneous bone fragility disorder, usually caused by collagen I mutations. It is well established that bisphosphonate treatment increases lumbar spine (LS) bone mineral density (BMD), as well as improves vertebral geometry in severe 01; however, fracture reduction has been difficult to prove, pharmacogenetic studies are scarce, and it is not known at which age, or severity of disease, treatment should be initiated.Materials and methods: COL1A1 and COL1A2 were analyzed in 79 children with OI (type I n = 33, type III n = 25 and type IV n = 21) treated with Pamidronate. Data on LS BMD, height, and radiologically confirmed non vertebral and vertebral fractures were collected prior to, and at several time points during treatment.Results: An increase in LS BMD Z-score was observed for all types of OI, and a negative correlation to A LS BMD was observed for both age and LS BMD Z-score at treatment initiation. Supine height Z-scores were not affected by Pamidronate treatment, The fracture rate was reduced for all OI types at all time points during treatment (overall p < 0.0003, < 0.0001 and 0.0003 for all 01 types 1, III and IV respectively). The reduced fracture rate was maintained for types I and IV, while an additional decrease was observed over time for type III. The fracture rate was reduced also in individuals with continued low BMD after >4 yrs Pamidronate. Twice as many boys as girls with 01 type I were treated with Pamidronate, and the fracture rate the year prior treatment was 2.2 times higher for boys (p = 0.0236). Greater Delta LS BMD, but smaller Delta fracture numbers were observed on Pamidronate for helical glycine mutations in COL1A1 vs. COL1A2. Vertebral compression fractures did not progress in any individual during treatment; however, they did not improve in 9%, and these individuals were all >11 years of age at treatment initiation. (p < 0.0001).Conclusion: Pamidronate treatment in children with all types of 01 increased LS BMD, decreased fracture rate, and improved vertebral compression fractures. Fracture reduction was prompt and maintained during treatment, irrespective of age at treatment initiation and collagen I mutation type. (C) 2016 Elsevier Inc. All rights reserved.