Predictive factors of non-treatment and non-persistence to osteoporosis medication after fragility hip fractures at 3 years after discharge: a multicentre, prospective cohort study in the northern Kyushu district of Japan

Abstract

We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication. Purpose Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan. Methods A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P). Results There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay. Conclusion Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.

Factors associated with non-initiation of osteoporosis pharmacotherapy after hip fracture: analysis of claims data in Japan

“…Male patients were over four times less likely to receive pharmacotherapy after a hip fracture than female patients. Lower treatment rates for men were also reported in the recent studies [ 12 , 15 ]. The risk of subsequent hip fracture is also high in men as in older women [ 7 , 34 ].…”

“…It is possible that physicians were more likely to prescribe osteoporosis drugs to patients who were at higher risk of falls and needed rehabilitation after surgery compared to those who did not. In a recent Japanese report, a low Barthel index, which is a common score for activities of daily living, was associated with non-pharmacotherapy [ 15 ]. In our sensitivity analysis using LTC care needs levels instead of dementia, admission to the recovery phase rehabilitation wards was still significantly associated with higher pharmacotherapy initiation, adjusting for LTC care needs levels.…”

“…In particular, the treatment initiation rate after hip fracture is low [ 12 – 14 ]. Some patient and healthcare provider factors for non-treatment for osteoporosis after fragility fracture include men, chronic kidney disease, patient perception, and clinical judgment [ 15 – 17 ].…”

CD137 Regulates Bone Loss via the p53 Wnt/β-Catenin Signaling Pathways in Aged Mice

“…The incidence of senile osteoporosis has shown to increase with advancing age. Senile osteoporosis is a health problem that commonly affects the elderly with an increased risk of hip fracture ( 4 , 5 ). Its action mechanism is that osteoporosis alters the trabecular microstructure of cancellous bone, which increases the fracture risk.…”