Monitoring fracture risk during antiosteoporotic therapy: a retrospective cohort study

Osteoporosis is among the leading socially significant diseases, with potential for early diagnosis and effective treatment. Appropriate selection of therapy, particularly after reassessment of ongoing antiosteoporotic therapy, can reduce both fracture risk and healthcare system costs. To evaluate strategies for reassessing antiosteoporotic therapy on the grounds of changes in fracture risk among women in the Bulgarian population. We conducted a retrospective observational cohort study including 300 participants women with postmenopausal, senile osteoporosis or low-energy fractures undergoing antiresorptive therapy. Data were collected at the time of discharge and during a 1-year follow-up period, covering a total monitoring period of 3 years. The FRAX score based on hip fracture (HF), proved to be a more sensitive predictor of future fractures ( HF > 4.5% in 65.22% with postmenopausal osteoporosis and in 100% with senile). In the bisphosphonate treatment group, total bone mineral density (BMD) of the lumbar spine (VL) and BMD оf the femoral neck (FN) demonstrated a clearer trend of BMD improvement (month 36: 0.838 g/cm² ± 0.01 SD and 0.622 g/cm² ± 0.04 SD ) compared to T-scores. BMD —particularly of the FN—and FN T-scores in patients at very high fracture risk were significant indicators for therapy reassessment. BMD of the FN consistently predicted changes in fracture risk across all monitoring periods. Implementing national strategies for the reassessment of antiosteoporotic therapy, on the grounds of evolving fracture risk, could enhance clinical decision-making and address existing gaps in the treatment of high-risk patients.