pp 1–11 | Cite as

Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk

  • Luca Degli EspostiEmail author
  • Anna Girardi
  • Stefania Saragoni
  • Stefania Sella
  • Margherita Andretta
  • Maurizio Rossini
  • Sandro Giannini
  • on the behalf of the Study group
Original Article



To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality.


This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality.


A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (N = 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420–0.735, p < 0.001) and 64.4% lower in those receiving calcium/vitamin D supplementation compared to osteoporosis treatment only (HR = 0.356, 95% CI = 0.237-0.533, p < 0.001). The risk of re-fracture was 77.2% lower in treated patients who were adherent to medication (HR = 0.228, 95% CI = 0.139–0.376, p < 0.001). Treated patients had 64% lower mortality risk over the follow-up compared to untreated ones (HR = 0.360, 95% CI = 0.310–0.418, p < 0.001).


A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.


Osteoporosis Calcium/vitamin D Treatment patterns Re-fracture risk Clinical setting 



We would like to thank all participants who took part in this study.

on the behalf of the Study group:

A. Vercellone5 and E. Nava5, F. Ferrante6, C. Bianchi6, S. Crescenzi6, P. F. Venditti6, M. Folcatrelli6, A. Constantini7, C. Cattaruzzi8


This study was sponsored unconditionally by Abiogen Pharma S.p.A, Pisa, Italy.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

12020_2018_1824_MOESM1_ESM.docx (13 kb)
Supplementary Information


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Luca Degli Esposti
    • 1
    Email author
  • Anna Girardi
    • 1
  • Stefania Saragoni
    • 1
  • Stefania Sella
    • 4
  • Margherita Andretta
    • 2
  • Maurizio Rossini
    • 3
  • Sandro Giannini
    • 4
  • on the behalf of the Study group
  1. 1.CliCon S.r.l. HealthEconomics & Outcomes ResearchRavennaItaly
  2. 2.UOC HTA, Azienda Zero—Regione VenetoVeronaItaly
  3. 3.Rheumatology UnitAzienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
  4. 4.Department of Medicine, Clinica Medica 1University of Padova and Regional Center for OsteoporosisPadovaItaly

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