1323: Secondary Prevention of Vertebral Fractures Sustained Efficacy over Time

JOSE ELOY OLLER RODRIGUEZ¹, Elena Grau García², Samuel Leal Rodriguez³, Laura Mas Sanchez², Pablo Francisco Muñoz Martínez⁴, Carmen Riesco Bárcena⁵, Anderson Huaylla Quispe⁶, Cristobal Pavez Perales², Francisco Miguel Ortiz Sanjuan⁷, José Ivorra Cortés², Inés Cánovas Olmos², Luis González Puig⁸, Isabel Martínez-Cordellat², Carmen Nájera Herranz⁷, Rosa Negueroles Albuixech², Elvira Vicens Bernabeu⁷, Alba Torrat Novés⁵, Daniel Ramos Castro² and José andrés Román ivorra³, ¹Hospital Universitario de La Fe, València, Spain, ²Rheumatology Department. Hospital Universitario y Politécnico La Fe, València, Spain, ³Hospital Universitari i Politécnic La Fe, València, Spain, ⁴Hospital Universitario y Politécnico La Fe, València, Spain, ⁵Rheumatology Department. Hospital Universitario y Politécnico La Fe, València, ⁶Medicina, València, Spain, ⁷Hospital Universitario de La Fe, València, ⁸Rheumatology Department. Hospital Universitario y Politécnico La Fe, Torrente, Valencia, Spain

Background/Purpose: 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.

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 Table 1. 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 of new fractures in patients treated with teriparatide followed by denosumab, being this probability greater in patients treated with teriparatide followed by oral bisphosphonate.

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%)

Conclusion: A lower probability of refracture was observed in patients who received sequential treatment with teriparatide followed by denosumab.

Disclosures: J. OLLER RODRIGUEZ, None; E. Grau García, None; S. Leal Rodriguez, None; L. Mas Sanchez, None; P. Muñoz Martínez, None; C. Riesco Bárcena, None; A. Huaylla Quispe, None; C. Pavez Perales, None; F. Ortiz Sanjuan, None; J. Ivorra Cortés, None; I. Cánovas Olmos, None; L. González Puig, None; I. Martínez-Cordellat, None; C. Nájera Herranz, None; R. Negueroles Albuixech, None; E. Vicens Bernabeu, None; A. Torrat Novés, None; D. Ramos Castro, None; J. Román ivorra, None.