Patient and physician predictors of post-fracture osteoporosis management.
BACKGROUND
Undertreatment of osteoporosis after hip or wrist fracture has been well documented, but the reasons for current patterns of care are poorly understood.


OBJECTIVE
We tested the role of physician and patient characteristics in predicting undertreatment when osteoporosis management was clearly indicated after a hip or wrist fracture in women over age 65.


METHODS
We assembled a cohort of 9,698 female Medicare beneficiaries aged > or = 65 years who experienced hip or wrist fracture between 2000 and 2004 and their prescribing physicians.


METHODS
The dominant prescriber was identified as the physician prescribing at least 50% of patient prescriptions in the year after the fracture. Multivariate logistic regression estimated the role of physician and patient characteristics on osteoporosis management after hip or wrist fracture.


RESULTS
Patients older than 90 and black patients were less likely to be treated for osteoporosis relative to patients aged 65-69 and white patients. Female providers were more likely to manage osteoporosis. Models including patient characteristics discriminated well between managed and unmanaged patients (C statistic 0.81), while adding physician predictors to the model provided no additional discriminatory ability (C statistic 0.81).


CONCLUSIONS
Our findings highlight that osteoporosis management rates are similar across providers, but vary considerably by patient types.
Block
Adam E
AE
Joint Committee on Taxation, US Congress, Washington, DC 20515, USA. adameblock@gmail.com
Solomon
Daniel H
DH
Cadarette
Suzanne M
SM
Mogun
Helen
H
Choudhry
Niteesh K
NK
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008485:Medical Audit; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011885:Radius Fractures / Q000188:drug therapy* / Q000534:rehabilitation; D012189:Retrospective Studies; D044465:White People
D050071:Bone Density Conservation Agents