Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject : Prevalence of Osteoporosis and Osteoporotic FracTure and ROle of Teriparatide in the Management of Osteoporosis (POFTO study)

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and poor bone quality (e.g., architecture, turnover, damage accumulation, and mineralization) leading to reduced bone strength and increased risk of fracture. It constitutes a major public health concern with 1 in 2 women and 1 in 5 men having a fragility fracture in their remaining lifetime after the age of 50 years. Globally the absolute number and associated illness burden have increased substantially over the past 3 decades such that in 2019 an estimated 178 million new fractures occurred and 455 million people suffered the effects of prior fractures. Today the direct cost of managing fragility fractures worldwide is estimated to be in excess of $100 billion USD with indirect costs close to $200 billion.

A recent network meta-analysis evaluating 73 osteoporosis trials reported a protective effect of bisphosphonates, denosumab, parathyroid hormone receptor agonists, and romosozumab for hip fractures compared with placebo. Treatment with bisphosphonates for 12 to 36 months and denosumab for 36 months markedly reduced the risk of clinical vertebral fractures (VFs) by 54% to 68% compared with placebo. Teriparatide exhibited a 76% risk reduction at 17 months, and romosozumab had an 82% reduction in the risk of clinical VFs at 12 months.

There is limited data on the prevalence of osteoporotic fractures in India. There are wide variations in the management of osteoporosis and osteoporotic fractures in India including the use of teriparatide. This real-world study will help to assess the prevalence of osteoporotic fractures, management approach and place and usage pattern of teriparatide in the treatment of osteoporotic fractures.

If you agree to participate, you will be required to respond to questions of the enclosed questionnaire. We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.