CLINICAL CHARACTERISTICS AND INCIDENCE OF FIRST FRACTURE IN A CONSECUTIVE SAMPLE OF POSTMENOPAUSAL WOMEN ATTENDING OSTEOPOROSIS CENTRES: THE PROTEO 1 STUDY

Background: Osteoporosis is a highly prevalent disease and fractures are a major cause of disability and morbidity. Aim: the purpose of this study was to characterise postmenopausal women attending osteoporosis centres in Italy, to evaluate physician management, and to determine the incidence of first osteoporotic fracture. Subjects and methods: PROTEO 1 was an observational longitudinal study with a 12-month follow-up. Data were collected from women attending osteoporosis centres. Women without prevalent fracture were eligible to enter the 1-year follow-up phase: the clinical approach to patients according to their fracture risk profile and the incidence of fracture were recorded. Results: 4269 patients were enrolled in 80 centres in the cross-sectional phase; 34.2% had an osteoporotic fracture at baseline. Patients with prevalent fractures were older and more likely to be treated compared with non-fractured patients. The incidence of vertebral or hip fracture after 1 year was 3.84%, regardless of the calculated risk factor profile, and was significantly higher in patients with back pain at baseline (4.2%) compared with those without back pain (2.2%; p = 0.023). Generally, physicians prescribed more blood exams and drugs to patients at higher risk of fracture. Among fractured patients only 24% were properly treated; the rate of non-responders to treatment was about 4%. Conclusions: in a large, unselected sample of postmenopausal women attending osteoporosis centres, those without previous fracture were at substantial risk of future fracture, regardless of their theoretical low 10-year fracture risk. The presence of back pain in women without previous fracture warrants close attention.