Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: a retrospective study

Abstract

BackgroundA vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, however, has not been well characterized in postmenopausal women in Asia. The purpose of this study was to characterize patient and health system characteristics associated with the diagnosis and management of osteoporosis among postmenopausal women hospitalized with a fragility fracture in Asia.MethodsPatient surveys and medical charts of postmenopausal women (N=1,122) discharged after a fragility hip fracture from treatment centers in mainland China, Hong Kong, Singapore, South Korea, Malaysia, Taiwan, and Thailand between July 1, 2006 and June 30, 2007 were reviewed for bone mineral density (BMD) measurement, osteoporosis diagnosis, and osteoporosis treatment.ResultsThe mean (SD) age was 72.9 (11.5) years. A BMD measurement was reported by 28.2% of patients, 51.5% were informed that they had osteoporosis, and 33.0% received prescription medications for osteoporosis in the 6 months after discharge. Using multivariate logistic regression analyses, prior history of fracture decreased the odds of a BMD measurement (OR 0.63, 95% CI 0.45-0.88). Having a BMD measurement increased the odds of osteoporosis diagnosis (OR 10.1, 95% CI 6.36-16.0), as did having health insurance (OR 4.95, 95% CI 1.51-16.21 for private insurance with partial self-payment relative to 100% self-payment). A history of fracture was not independently associated with an osteoporosis diagnosis (OR 0.80, 95% CI 0.56-1.15). Younger age reduced the odds of receiving medication for osteoporosis (OR 0.59, 95% CI 0.36-0.96 relative to age ≥65), while having a BMD measurement increased the odds (OR 1.79, 95% CI 1.23-2.61).ConclusionsOsteoporosis diagnosis and treatment in Asian countries were driven by BMD measurement but not by fracture history. Future efforts should emphasize education of general practitioners and patients about the importance of fracture.

How well are we managing fragility hip fractures? A narrative report on the review with the attempt to setup a Fragility Fracture Registry in Hong Kong

“…29 A local study showed that 33% were prescribed medications for osteoporosis in the 6 months after discharge. 30 Osteoporosis diagnosis and treatment were driven by BMD measurement, not fracture history. 30 This may explain the low prescription rate of bone protection medication when the fracture patient did not undergo BMD measurement for a variety of reasons such as unavailability of dual-energy X-ray absorptiometry (DXA), long queuing time, or lack of referral from orthopaedic doctors.…”

“…30 Osteoporosis diagnosis and treatment were driven by BMD measurement, not fracture history. 30 This may explain the low prescription rate of bone protection medication when the fracture patient did not undergo BMD measurement for a variety of reasons such as unavailability of dual-energy X-ray absorptiometry (DXA), long queuing time, or lack of referral from orthopaedic doctors. Although the need for DXA measurement prior to prescription of bone health medication to patients with fragility fracture remains controversial, it is clear that DXA measurement is not the only single indication for such medication.…”

Bisphosphonate-functionalized hyaluronic acid showing selective affinity for osteoclasts as a potential treatment for osteoporosis

“…We quantified the effect of H-HA and L-HA as well as H-HA-BP and L-HA-BP in comparison with the parent pamidronate on the survival and proliferation of RANKL-induced murine osteoclast-like cells using a standard TRAP assay. 42 Fig. 2 and 3).…”

Romosozumab or alendronate for fracture prevention in East Asian patients: a subanalysis of the phase III, randomized ARCH study

“…Despite this, osteoporosis remains alarmingly underdiagnosed and undertreated in Asia, even among patients who have already sustained a fragility fracture. In a study of over 1000 postmenopausal women with hip fractures from seven countries in Asia, only one in three underwent bone mineral density (BMD) testing and received osteoporosis medications after discharge [13].…”