Use of Osteoporosis Medications after Hospitalization for Hip Fracture: A Cross-national Study

Abstract

Purpose While current osteoporosis management guidelines recommend use of pharmacologic treatment following hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study is to quantify the use of and adherence to osteoporosis medication following hip fracture in three countries with different health care systems- the United States, Korea and Spain. Methods In three cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year following the hip fracture. Results We identified 86,202 patients with a hip fracture - 4,704 (U.S. Medicare), 6,700 (U.S. commercial), 57,631(Korea), and 17,167 (Spain). The mean age was 77–83 years and 74–78% were women. In the year prior to the index hip fracture, 16–18% were taking an osteoporosis medication. Within 3 months following the index hip fracture, 11% (U.S. Medicare), 13% (U.S. commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled one or more prescriptions for an osteoporosis medication, the mean PDC in the year following the fracture was 0.70 (U.S. Medicare), 0.67 (U.S. commercial), 0.43 (Korea) and 0.66 (Spain). Conclusions Regardless of differences in health care delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal with the PDC<0.70 in all three countries.

Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey

“…This latter study also reported that in the USA the proportion of patients who received an osteoporosis medication was lower after the index hip fracture than before [15]. Moreover, several studies carried out in both the USA and Europe reported that over the past decade there was a significant decrease in the rate of osteoporosis medication after hip fracture, which may be related to concerns over potential side effects of bisphosphonates [15,18]. The reasons for the gap between national and international evidence-based treatment guidelines [10,19] and treatment rates remain unclear and have been debated in several studies [8,20].…”

“…Moreover, this latter study also reported that of the patients who were treated, only 41% were continuing with their treatment by the end of the first year, and fewer than half were found to be compliant [8]. A recent cross-national study by Kim et al [15] reported that the use of osteoporosis medications after hospitalization for hip fracture ranged from 11% in the USA to 38% in Korea. This latter study also reported that in the USA the proportion of patients who received an osteoporosis medication was lower after the index hip fracture than before [15].…”

“…A recent cross-national study by Kim et al [15] reported that the use of osteoporosis medications after hospitalization for hip fracture ranged from 11% in the USA to 38% in Korea. This latter study also reported that in the USA the proportion of patients who received an osteoporosis medication was lower after the index hip fracture than before [15]. Moreover, several studies carried out in both the USA and Europe reported that over the past decade there was a significant decrease in the rate of osteoporosis medication after hip fracture, which may be related to concerns over potential side effects of bisphosphonates [15,18].…”

“…Notwithstanding, many studies have reported that a significant proportion of hip fracture patients do not receive any treatment for osteoporosis. In fact, literature data indicate that the proportion of patients with recent hip fracture who receive a prescription of anti-osteoporotic drugs varies between 15 and 40% and does not seem to increase over time in any Western countries [15]. On the contrary, in more recent years the use of bisphosphonates, the most commonly used group of anti-osteoporotic drugs after hip fracture, decreased significantly over the years in both the USA and some European countries [15].…”

“…In fact, literature data indicate that the proportion of patients with recent hip fracture who receive a prescription of anti-osteoporotic drugs varies between 15 and 40% and does not seem to increase over time in any Western countries [15]. On the contrary, in more recent years the use of bisphosphonates, the most commonly used group of anti-osteoporotic drugs after hip fracture, decreased significantly over the years in both the USA and some European countries [15]. At present, in Italy very few data are available on the percentage of patients with recent hip fracture who are receiving prescriptions for anti-osteoporotic drugs.…”