(068) Contemporary Management of Patients After Hip Fracture. A Population-Based Cohort of Over 120.000 Patients in Spain.

Background: During the last decade, the availability of zoledronic acid and denosumab is likely to have changed the pharmacological management of patients after hip fracture, but there is a scarcity of information on the extent of this in routine clinical practice.

Objectives: To evaluate the contemporary management of patients who suffered a hip fracture in a population-based cohort using real-world data of 4 different regions in Spain, accounting for 32% of the total Spanish population over 11 years.

Methods: Population-based retrospective cohort of all patients aged 65 years and over, discharged alive following hip fracture hospitalisation (2008-2021) in 4 regions of Spain (Basque Country, Catalonia, Navarre, Valencia Region) within the (universal) Spanish National Health System. Patients were followed for a minimum of 365 days. Therapeutic management ascertainment: Based on electronic pharmacy data, we examined whether a prescription was issued (filled or not) for the drugs of interest. Statistical Analysis: We first described the baseline characteristics of the cohort. Then, the proportion of patients prescribed any antiosteoporotic (AO) and specific classes in the first 90 days after discharge, were evaluated for the whole cohort. We also assessed treatment patterns in the last year available, to have accurate information of recent patterns. Temporal trends of treatment prescription per month were plotted according to therapeutic strategy for each one of the regions. The same analyses were repeated by sex and age ranges.

Results: The study population comprised 121.470 patients discharged alive after a hip fracture. The mean age was 84.0 years (SD: 7.1), with 50% being 85 years of age or over, and 76% being female; 18% had a baseline diagnosis of osteoporosis and 17% had a previous fracture. 21% of patients were prescribed AO (14% biphosphonates, 4.5% denosumab, 2% Teriparatide/PTH and 0.5% other medications) during the study period. In the last year available, 26% of patients were treated with AO. By sex, overall, the Mediterranean regions showed greater differences, with notably higher treatment rates for females; whereas the Northern regions showed lesser differences. By age, three out of the four regions showed lower AO treatment rates after hip fracture for the oldest group (85+) as compared to the other two age groups, along the study period. Time trends of treatment by drug class and for each sub-cohort showed that treatment with bisphosphonates dropped, whereas denosumab treatment rose, along the study period, showing an opposite pattern of use in all of the regions.

Conclusions: Despite changes in the drug class prescribed, contemporary treatment with AO after hip fracture remains highly suboptimal in real-world practice in Spain, especially among the eldest.