Current osteoporosis management among Australians at high-risk of osteoporotic fractures: an overview from the 45&Up Study cohort — The Association Specialists
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Current osteoporosis management among Australians at high-risk of osteoporotic fractures: an overview from the 45&Up Study cohort (428)

Jian Sheng Chen 1 , Judy Simpson 2 , Fiona Blyth 3 , Lyn March 1
  1. Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia
  2. Sydney School of Public Health, University of Sydney, Sydney
  3. Concord Clinical School, University of Sydney , Concord

Background

Osteoporosis management among high-risk individuals is not well understood in Australia.

Methods

The study subjects are from the 45&Up Study which recruited about 1 in 10 men and women aged ≥45 years in NSW during 2005-2009. Fracture Risk Assessment Paper Charts (Australia), FRAX, were used to calculate the 10-year fracture probability for participants after excluding participants who were aged <50 years, had missing body mass index data, or were on anti-resorptive therapies for non-osteoporosis diseases. Participants with a 10-year probability of hip (or major osteoporotic) fracture of ≥3.0% (or 20%) or a prior fracture history were considered high-risk and should be considered for anti-osteoporosis treatment (anti-resorptive agent or teriparatide) based on cost-effectiveness. The high-risk rates were standardised to the Australian population distribution at 30th June 2007. The standardised rates for treatment under the current treatment guidelines (BMD T-score ≤ -2.5 or fragility fracture) were also estimated from rates of T-score ≤ -2.5 in the Geelong Osteoporosis Study Cohort plus 45% of the reported prior fracture prevalence in the 45&UP Study. Information on drug use and BMD testing (rates) within one year before and one year after the recruitment date were ascertained from the Pharmaceutical and Medical Benefits Schemes database.

Results

Of the 213,375 participants, 64,249 (30.1%) could be considered at high-risk of fractures. Among the high-risk participants, the rates of the treatment and BMD testing were low (17.1% and 17.2% respectively) but were much higher in women (24.5% and 22.8%) than in men (7.4% and 9.6%). There was a small difference in the standardised rate of high-risk of fractures and the standardised rate of qualifying for pharmacologic therapy  among Australians aged <70 years (11.1% vs 12.7% respectively). For those aged ≥70 years, many more participants could be recommended for treatment on the ground of cost-effectiveness than on the current treatment guidelines (men 63.2% vs 16.3% and women 89.6% vs 51.4%).

Conclusion

In Australia, osteoporosis management was suboptimal among high-risk individuals especially among men. The initiation of pharmacologic therapy should also be recommended based on absolute fracture risk and new treatment thresholds should therefore be established.