Osteoporosis Treatment Prescription in Very High-Risk Fracture Population: A Single-Centre Experience
https://doi.org/10.15605/jafes.041.S1
- Author:
Victoria Wei Fang Boey
1
;
Hwee Ching Tee
2
;
Jin Hui Ho
2
Author Information
1. Department of Medicine, Hospital Tuaran
2. Endocrine Unit, Department of Medicine, Hospital Queen Elizabeth II
- Publication Type:Journal Article
- MeSH:
Prescriptions;
Osteoporosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):69-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Osteoporosis is associated with increased fracture risk,
leading to significant morbidity and mortality. Despite
established clinical guidelines, a substantial gap remains
between recommended and actual prescribing practices.
Patients at very high fracture risk have poorer outcomes
and are recommended to receive anabolic or parenteral
antiresorptive therapies. However, access to these
treatments is limited in Malaysian government hospitals
due to cost constraints.
Methodology:This retrospective clinical audit evaluated osteoporosis
treatment prescriptions among very high-risk patients
attending the Osteoporosis Endocrine Clinic at Hospital
Queen Elizabeth II from 2020 to 2025. Very high fracture
risk was defined according to the American Association
of Clinical Endocrinologists criteria, including recent
fractures, fractures on therapy, multiple fractures, high fall
risk, glucocorticoid use, very high FRAX probability (>30%
major osteoporotic fracture or >4.5% hip fracture), or very
low bone mineral density (T-score <−3.0).
Results:A total of 120 patients were included, with a median age
of 68 years (interquartile range [IQR] 62–73). Most were of
Chinese ethnicity (60%, n = 72), with a median body mass
index of 22.6 kg/m² (IQR 19.6–26). Secondary osteoporosis
was present in 70% of patients, commonly due to aromatase
inhibitor use (45%), glucocorticoid-induced osteoporosis
(13.3%), thyroid disorders (10.8%), and vitamin D insufficiency (9.2%). Only 12% of patients (n = 14) received anabolic or parenteral antiresorptive therapy, while 88% (n =
106) were treated with oral alendronate. Among those on
alendronate, 19.8% (n = 21) developed adverse outcomes,
including treatment failure (n = 13), gastrointestinal side
effects (n = 6), and atypical femoral fractures (n = 2).
Conclusion:The uptake of guideline-recommended therapy in very
high-risk osteoporosis patients remains low. A notable proportion of patients treated with oral alendronate
experienced adverse outcomes or suboptimal responses.
Addressing financial and systemic barriers is crucial to
improving access to advanced therapies and optimizing
patient outcomes.
- Full text:2026080317094910999EP_A090.pdf
