'Dismal' rates of osteoporosis treatment initiation after hip fracture
medwireNews: The proportion of patients initiating osteoporosis medication following hip fracture has declined in recent years, despite treatment reducing subsequent fracture risk, analysis of a US medical claims database suggests.
Of 97,169 patients aged an average of 80.2 years who were not taking osteoporosis medication at the time of hip fracture, only 6.9% initiated treatment with bisphosphonates, teriparatide, or denosumab within 180 days of their fracture.
Rishi Desai (Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA) and team observed a continuous decline in medication initiation rates over time for these patients, from 9.8% in 2004 to 3.3% in 2015.
This decrease occurred despite a “clinically meaningful reduction” in the risk for subsequent nonvertebral fracture rates with the use of osteoporosis medication, report the researchers in JAMA Network Open.
In all, 203 nonvertebral fracture events occurred over 3798 person–years of follow-up among patients initiating osteoporosis medication after their index fracture, compared with 1737 events over 26,688 person–years for those who did not initiate treatment.
These results translate into incidence rates of 5.34 and 6.50 per 100 person–years for patients who did and did not initiate osteoporosis medication, respectively, giving a rate difference of 4.2 events per 100 person–years on instrumental variable analysis accounting for factors including calendar year and hospital preference.
Writing in an associated commentary, Douglas Bauer (University of California, San Francisco, USA) points out that these results add to “a wealth of evidence about the markedly elevated fracture risk and the availability of effective and safe treatments,” and that the low treatment rates “can only be described as a shocking failure to provide adequate care to a high-risk population.”
He suggests that a number of different reasons could explain “this dismal state of affairs,” including drug contraindications, patient and family preference, insurance issues, clinical inertia, and lack of awareness among primary care providers.
“To reverse these trends, we need to actively screen selected patients for osteoporosis risk factors, and in particular, use information technology to identify those who have had a hip or other osteoporotic fracture,” he adds.
And Bauer concludes: “Once identified, patients who have had a previous fracture can be counseled about fall prevention strategies and effective drug therapy to avoid additional fractures.”
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