Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011

Abstract

Hip fractures are common, morbid, costly, and associated with subsequent fractures. Historically, postfracture osteoporosis medication use rates have been poor, but have not been recently examined in a large-scale study. We conducted a retrospective, observational cohort study based on U.S. administrative insurance claims data for beneficiaries with commercial or Medicare supplemental health insurance. Eligible participants were hospitalized for hip fracture between January 1, 2002, and December 31, 2011, and aged 50 years or older at admission. The outcome of interest was osteoporosis medication use within 12 months after discharge. Patients were censored after 12 months, loss to follow-up, or a medical claim for cancer or Paget's disease, whichever event occurred first. During the study period, 96,887 beneficiaries met the inclusion criteria; they had a mean age of 80 years and 70% were female. A total of 34,389 (35.5%) patients were censored before reaching 12 months of follow-up. The Kaplan-Meier estimated probability of osteoporosis medication use within 12 months after discharge was 28.5%. The rates declined significantly from 40.2% in 2002, to 20.5% in 2011 (p for trend <0.001). In multivariable Cox proportional hazards models, a number of patient characteristics were associated with reduced likelihood of osteoporosis medication use, including older age and male gender. However, the predictor most strongly and most positively associated with osteoporosis medication use after fracture was osteoporosis medication use before the fracture (hazard ratio = 7.45; 95% confidence interval [CI], 7.23–7.69). Most patients suffering a hip fracture do not use osteoporosis medication in the subsequent year and treatment rates have worsened. © 2014 Eli Lilly and Company. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Assessment of the antiosteoporotic treatment initiation: A retrospective observational study in Greece

“…Furthermore, various studies have shown that of the patients who have had a low trauma fracture just about 20% receive treatment for osteoporosis 29,30 . Patients being unaware and having limited knowledge regarding osteoporosis, its consequences and the benefit of treatment is a significant reason for osteoporosis undertreatment 31,32 . A limitation of this study is that the main source of data was clinical files but since at the time in Greece public hospitals and medical centres held no electronic records and faced lack of staff, there is a possibility that the patients' medical history was not fully recorded.…”

Revisión de la incidencia de la fractura de cadera en España

“…In addition, it is worth noting that, despite improvements in anesthesia and control of infections after surgery, the mortality rate for this type of fracture has barely changed in recent decades 24,25 . Furthermore, the use of anti-osteoporotic drugs after hip fracture remains low and may even be decreasing 23 . In the past decade, advances in the understanding of the patho-physiology of osteoporosis and the development of anti-resorptive and osteoforming drugs make it essential that these patients be evaluated and monitored by teams of specialists with specific training in this field, which has been designated in recent studies 26 cost-effectiveness.…”

Синдром Дисмобільності: Зміна Парадигми В Царині Профілактики Переломів

“…Despite a worldwide increase in the older adult population, with concomitant increase in number of fragility fractures and their attendant morbidity, mortality and healthcare costs, fewer people are receiving medication to reduce fracture risk even following fracture [1,2]. This failure to treat has recently been described as a "crisis" in osteoporosis care [3].…”

“…The FLS paradigm consists of a systematic approach to identify those who have sustained a fragility fracture and subsequently execute appropriate evaluation to investigate secondary causes of bone loss and initiate pharmacologic therapy to reduce fracture risk [6]. The FLS approach has been widely studied and validated to reduce fractures and healthcare expenditures [1,7].…”