Trends in drug prescribing for osteoporosis after hip fracture, 1995-2004.
OBJECTIVE
To examine trends in osteoporosis drug prescribing after hip fracture from 1995 to 2004.


METHODS
We conducted a population-based study of enrollees in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly. Hip fractures were identified using Medicare hospital claims between January 1, 1995, and June 30, 2004. Osteoporosis treatment comprised oral bisphosphonates, calcitonin, hormone therapy, raloxifene, and/or teriparatide. Kaplan-Meier methods were used to estimate the probability of treatment within 6 months of fracture, censoring patients on their date of death or 6 months postfracture.


RESULTS
Treatment within 6 months after hip fracture improved from 7% in 1995 to 31% in 2002, and then remained stable through 2004. Similar patterns were observed among new users, with treatment increasing from 4% in 1995 to 17% in 2002, with no subsequent increase through 2004. Bisphosphonates led other treatments in the frequency of prescribing, except during 1997-99, when calcitonin was the most common. Among women, hormone therapy prescribing decreased from 22% of those treated in 1995 to 4% in 2004, and raloxifene prescribing remained relatively constant (4%-10%) since its introduction (p for trend = 0.15). Of patients treated before and after hip fracture, 18% changed therapy postfracture. Significantly more patients changed therapy following fracture if a different physician prescribed treatment (26%) compared to those treated by the same physician pre- and postfracture (13%; p < 0.0001).


CONCLUSIONS
Prescribing practices changed substantially over the 10 years of study. The proportion of hip fracture patients treated with osteoporosis drugs has increased, but remains low, with fewer than one-third receiving pharmacotherapy.
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA. s.cadarette@utoronto.ca
Suzanne M
SM
Cadarette
Jeffrey N
JN
Katz
M Alan
MA
Brookhart
Raisa
R
Levin
Margaret R
MR
Stedman
Niteesh K
NK
Choudhry
Daniel H
DH
Solomon
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies
D050071:Bone Density Conservation Agents