Prevención de fractura osteoporótica en España: uso de fármacos antes y después de una fractura de cadera

espanolIntroduccion: El tratamiento de la osteoporosis se orienta a prevenir la fractura por fragilidad, siendo la fractura de cadera la que mas morbilidad y mortalidad produce. La existencia de una fractura previa es un importante predictor para una nueva fractura. Objetivo: Pretendemos analizar como varia el tratamiento de la osteoporosis antes y despues de una fractura de cadera. Material y metodos: A partir de las 4.126.030 historias clinicas de la Base de Datos para la Investigacion Farmacoepidemiologica en Atencion Primaria (BIFAP) 2011 de toda Espana, se obtuvo informacion de pacientes con una primera fractura de cadera registrada entre 2005-2011, con seguimiento anterior y posterior de al menos un ano. Analizamos el tratamiento previo y posterior para la osteoporosis (incluyendo suplementos de calcio y vitamina D). Resultados: Sufrieron una fractura de cadera 2.763 pacientes mayores de 60 anos (media 81 anos), de los que el 81,6% eran mujeres. Antes de la fractura, el 26,5% (intervalo de confianza [IC] 95%: 24,8-28,1%) habian recibido algun tratamiento antiosteoporotico, de los que el 12,2%, (IC 95%: 11,0-13,5%) era bisfosfonatos. Tras la fractura lo recibieron un 38,6% (IC 95%: 36,8-40,4%), fueron tratados con bisfosfonato 20,4% (IC 95%: 18,9-22%). Los factores asociados a iniciar un tratamiento tras la fractura fueron ser mujer, mas joven y con diagnostico previo de osteoporosis. Conclusiones: La mayoria de los pacientes estudiados no estaban recibiendo tratamiento preventivo antes de su fractura de cadera. Tras ella, aumento modestamente la prescripcion. Los farmacos mas frecuentemente anadidos fueron calcio, vitamina D y bisfosfonatos. EnglishIntroduction: Treatment of osteoporosis is focussed on the prevention fragility fractures, fractures of the hip being those which produce the highest rates of morbidity and mortality. The existence of a previous fracture is an important predictor of a new fracture. Objective: we intend to analyse how treatment for osteoporosis varies before and after a hip fracture. Material and methods: Using the 4,126,030 clinical records in the database for pharmaco-epidemiological research in primary care (Base de Datos para la Investigacion Farmacoepidemiologica en Atencion Primaria [BIFAP] ) 2011 for the whole of Spain, information was obtained regarding patients who had a first hip fracture recorded between 2005-2011, having been monitored for at least a year before and after. We analyse the previous and subsequent treatment for osteoporosis (including calcium and vitamin D supplements). Results: 2,763 patients over 60 years of age (average 81 years) had suffered a hip fracture, of whom 81.6% were women. Before the fracture 26.5% (95% confidence interval [CI]: 24.8-28.1%) had received some antiosteoporotic treatment, of which 12% (95% CI: 11.0-13.5%), were bisphosphonates. 38.6% (95%CI: 36.8-40.4%) received treatment after the fracture, 20.4% (95%: 18.9-22%) treated with bisphosphonates. The factors associated with the initiation of treatment after the fracture were being a woman, being younger and having a previous diagnosis of osteoporosis. Conclusions: Most of the patients studied were not receiving preventative treatment before their hip fracture. After the fracture the prescription of treatment increased a little. The drugs most commonly added were calcium, vitamin D and bisphosphonates.