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Background: Osteoporosis (OP) between men and women is different,and the way it is treated also differs. In men, the gap in clinical care, especially diagnosis and treatment, is worse.
Objectives: To analyze the differences in the clinical characteristics of OP (demographics, comorbidities, diagnosis, and treatment) in an gold star Fracture Liaison Service (FLS).
Methods: Design: Observational, prospective, analytical study of usual clinical practice. All patients treated from an FLS from May 2018 to August 2021 were prospectively included. Of each patient, 160 clinical variables were introduced in a real time database, and they were followed for 2 years.
Results: 557 patients were analyzed, 472 (83%) women and 100 (17%) men. The main features are summarized in the table. In women the vertebral fracture predominated followed by the hip fracture, in men the hip followed by the vertebral ones. Men had higher rates of smoking and alcoholism. The frequency of secondary OP and exercise was different between sexes. Weight, height, and BMI were different, due to different body composition. The frequency of specific treatment for OP (bisphosphonate, denosumab, teripatide, SERM) before fracture was very low, lower in men.
The most remarkable result was the low percentage of patients with OP receiving treatment before the FLS, and the differences between sex; 77 (16%) women versus 6 (6%) men had received it at some point in their lives, p=0.008. The probability of a man not receiving prior treatment was 2. 70 (95%CI 1.13- 7.81); p=0,008. After the FLS all the patients were treated. Treatment adherence in the first two years after the FLS was 84% in both sexes.
Conclusion: OP is different between women and men. The probability of not receiving treatment in men was higher among men, these differences disappeared after care in FLS.
| Variable | Hipn, %239, 43 | Vertebraln, %159, 28 | DERn, %96, 17 | Humerusn, % 41, 7 | Othern, % 37, 6 | p | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Women | Men | Women | Men | Women | Men | Women | Men | Women | Men | 0.0001 | |
| Number | 179, 75 | 60, 25 | 129, 81 | 30, 19 | 93, 97 | 3, 3 | 40, 98 | 1, 2 | 31, 84 | 6, 16 | 0.06 |
| Current smoker | 13, 8 * | 19, 32 | 20, 16 * | 14, 48 | 16, 17 * | 1, 33 | 3, 8 | 0, 0 | 8, | 1 | 0.3 |
| Drinker >3 cups/day | 5, 3 * | 14, 24 | 9, 7 * | 11, 38 | 6, 6 | 1, 33 | 2, 5 | 0, 0 | 2, 6 | 0 | 0.001 |
| Secondary causes of OP | 24, 16 | 10, 21 | 24, 22 | 14, 56 | 14, 18 | 0, 0 | 11, 32 | 0, 0 | 9, 32 | 1, 20 | 0,03 |
| Exercise | 0,0001 | ||||||||||
| Bed to armchair | 35, 28 * | 12, 21 | 10, 8* | 8, 28 | 1, 1 | 0, 0 | 3, 8 | 1, 3* | 2, 33 | ||
| Wanders at home | 64, 0 | 13, 23 | 36, 30* | 5, 17 | 7, 8 | 0, 0 | 5, 13 | 11, 38 | 1, 17 | ||
| Walk in the street | 58, 36 | 26, 46 | 53, 43 | 15, 52 | 59, 68 | 2, 67 | 25, 64 | 10, 34 | 3, 50 | ||
| Daily exercise | 4, 2 | 5, 9 | 22, 18 | 1, 3 | 20, 23 | 6, 15 | 7, 24 | 0, 0 | |||
| Total | 161, 74 | 56, 26 | 121, 81 | 29, 19 | 87, 97 | 1, 33 3, 3 | 39, 100 | 29, 82 | 6, 17 | ||
| BMI ≥ 30 | 53, 32 | 14, 25 | 51, 43 | 13, 46 | 38, 43* | 3, 7 | 17, 45 | 1, 5 | 9, 29 | 2, 40 | 0.01 |
| OP treatment before FF | 26, 15 * | 2, 3 | 28, 23 * | 3, 10 * | 13, 15 | 0, 0 | 6, 16 | 0, 0 | 4, 14 | 1, 20 | 0,008 |
| Re-fracture (one year) | 11, 9 | 4, 8 | 6, 7 | 0, 0 | 5, 8 | 0, 0 | 2, 8 | 1, 100 | 0, 0 | 0, 0 | 0.9 |
| Mean± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean± SD | Mean ± SD | Mean ± SD | Mean± SD | Mean± SD | ||
| Age, Years | 79±8.7* | 75.5 ±10.3 | 70.4±9.0 | 69.3±10.0 | 69±9.2 | 73.6±6.5 | 71.3± 8.7* | 76 | 68.6±11.3 | 82.6±8.3 | 0.6 |
| Weight, Kg | 65.3±14,3* | 72.1±12.9 | 67.2±13.4 | 78.5±14.9 | 70.7±12.1 | 85.5±13.4 | 71.7±11.8 | 90 | 68.6±18.6* | 77.7±19.4 | 0.00001 |
| Size, m | 1.5±0.06* | 1.64±0.06 | 1.51±0.01 | 1.63±0.06 | 1.54±0.06 | 1.6±0.06 | 1.54 ±0.06 | 1,63 | 1.54±0.06* | 1.61±0.09 | 0.00001 |
| BMI | 28.4 ±5.1* | 26.7±4.1 | 29.2 ±6.3 | 29.1±4.8 | 29.9±5.4 | 33.2±2.6 | 30.1±4.9 | 33.8 | 28.9±6.7 | 29.4± 6.2 | 0,04 |
DER= distal end of radius, Others included ribs, tibia and fibula, distal end of femur. BMI Body mass index. *p value between women and men in each group of fragility fractures.
Disclosure of Interests: Blanca Hernández-Cruz Speakers bureau: Abbvie, Lilly, Stada, UCB, GebroPharma, Nordic, Consultant of: Abbvie, MSD, Lilly, Stada, UCB, Maria José Miranda García: None declared, Julia Barrera: None declared, Francisco Jesús Olmo Montes: None declared, María Angeles Vázquez Gómez: None declared, Mercedes Giner García: None declared, Miguel Angel Colmenero Camacho: None declared, José Javier Pérez Venegas: None declared, María José Montoya García: None declared