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Background: Vertebral fractures entail a notorious social and health problem, and their presence is the greatest risk factor for the appearance of a new vertebral fracture. Despite the availability of different drugs for secondary prevention, there are few comparative studies in real clinical practice.
Objectives: Our aim is to evaluate the appearance of new vertebral fractures depending on the strategy chosen as secondary prevention.
Methods: We performed a retrospective descriptive study with patients who had suffered their first vertebral fracture between 2010 and 2018, in whom we checked the subsequent appearance of new vertebral fractures.
We selected only those patients who had completed a minimum of 18 months of secondary prevention with antiresorptive drugs, or a sequential scheme (anabolic treatment followed by at least 1 year with an antiresorptive drug). Those patients who had presented new fractures in the first 6 months of treatment were excluded. Finally, we adjusted efficacy by treatment time.
Results: A total of 452 patients were included, out of an initial baseline pool of 1184 patients. We found female predominance (83% of the total). The mean age of the first vertebral fracture was 69.2 years, with a mean latency to fracture of 51.4 months. A new vertebral fracture happened in 4.7% of these patients.
The different secondary prevention strategies were classified according to the different therapeutic options, as we can see in
| Treatment | Patients (%) | New fractures (%) |
|---|---|---|
| Denosumab | 205 (45.35%) | 10 (4.87%) |
| Oral bisphosphonate (alendronate, risedronate or ibandronate) | 75 (16.59%) | 5 (6.66%) |
| Zoledronate | 38 (8.41%) | 3 (7.89%) |
| Teriparatide followed by Denosumab | 94 (20.8%) | 0 (0%) |
| Teriparatide followed by Oral bisphosphonate | 36 (7.96%) | 3 (8.33%) |
| Teriparatide followed by Zoledronate | 4 (0.89%) | 0 (0%) |
No statistically significant differences between different treatments were observed, but we found a lower probability of a new fracture in patients treated with sequential treatment with teriparatide followed by denosumab.
Finally, the Kapplan-Meier survival analysis showed a lower probability per year of new fractures in patients treated with teriparatide followed by denosumab, being this probability greater in patients treated with teriparatide followed by oral bisphosphonate.
Conclusion: A lower probability of refracture was observed in patients who received sequential treatment with teriparatide followed by denosumab.
Disclosure of Interests: None declared