title: Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces.
abstract: The study explores osteoporosis medication prescribing across Canadian provinces and any impact on hip fracture rates. Despite a marked variation in the prescribing of such medication, there is no effect on the hip fracture rate in either gender or any age group, suggesting either poor targeting or lack of efficacy.
  
  
  BACKGROUND
  Hip fractures are the most disabling and costly of osteoporotic fractures, and a reduction in the risk of hip fracture is an expectation of osteoporosis medications. In this study, we have compared the use of osteoporosis medication across Canadian provinces with the rate of hip fractures in the same regions.
  
  
  METHODS
  Three years of hip fracture data (2007-2009 inclusive) were obtained from the Canadian Institute for Health Information for all Canadian provinces excluding Quebec. Population information was obtained from Statistics Canada and medication information from the Brogan Inc. database. Because osteoporosis medication is available daily, weekly, monthly, and yearly, medication prescriptions were converted to "units" of prescribing, so that a once a year infusion represented 365 units, a monthly prescription 30 units, and so forth.
  
  
  RESULTS
  There is a fourfold difference in prescribing across provinces but no corresponding variation in hip fracture rate. No significant correlation exists between prescribing load and hip fracture rate. This was true for all age groups, both genders, and for both intertrochanteric and subcapital hip fracture.
  
  
  CONCLUSIONS
  We find no association between osteoporosis medication prescribing and hip fracture rate. Possible explanations include insufficient numbers of at-risk patients on treatment, inappropriate targeting, and either lack of efficacy or efficacy limited to only certain subgroups of patients such as those with demonstrable trabecular osteoporosis.
authors.affiliation: Division of Geriatric Medicine, Faculty of Medicine, The University of Western Ontario, London, Ontario, Canada, richard.crilly@sjhc.london.on.ca.
authors.forename: R G
authors.initials: RG
authors.lastname: Crilly
authors.forename: M
authors.initials: M
authors.lastname: Kloseck
authors.forename: B
authors.initials: B
authors.lastname: Chesworth
authors.forename: S
authors.initials: S
authors.lastname: Mequanint
authors.forename: E
authors.initials: E
authors.lastname: Sadowski
authors.forename: J
authors.initials: J
authors.lastname: Gilliland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D050071:Bone Density Conservation Agents
references.citation: J Bone Miner Res. 1992 Jul;7(7):755-9
references.pmid: 1642144
references.citation: J Bone Joint Surg Am. 2008 Oct;90(10):2142-8
references.pmid: 18829912
references.citation: N Engl J Med. 2001 Feb 1;344(5):333-40
references.pmid: 11172164
references.citation: Aten Primaria. 2011 Feb;43(2):82-8
references.pmid: 20554353
references.citation: JAMA. 2009 Aug 26;302(8):883-9
references.pmid: 19706862
references.citation: N Engl J Med. 2009 Aug 20;361(8):756-65
references.pmid: 19671655
references.citation: J Rheumatol. 2008 Sep;35(9):1865-73
references.pmid: 18709688
references.citation: Am J Med. 1985 Mar;78(3):487-94
references.pmid: 3976707
references.citation: CMAJ. 2010 Nov 23;182(17):1864-73
references.pmid: 20940232
references.citation: J Bone Miner Res. 2012 Jun;27(6):1243-51
references.pmid: 22392538
references.citation: JAMA. 2004 Apr 28;291(16):1999-2006
references.pmid: 15113819
references.citation: BMC Musculoskelet Disord. 2013 Feb 22;14:68
references.pmid: 23432767
references.citation: Arch Intern Med. 2004 May 24;164(10):1108-12
references.pmid: 15159268
references.citation: PLoS One. 2011;6(7):e22227
references.pmid: 21799797
references.citation: Am J Epidemiol. 1993 Feb 1;137(3):342-54
references.pmid: 8452142
references.citation: J Am Geriatr Soc. 2010 Apr;58(4):650-7
references.pmid: 20398147
references.citation: Lancet. 1993 Jan 9;341(8837):72-5
references.pmid: 8093403
references.citation: JAMA. 1998 Dec 23-30;280(24):2077-82
references.pmid: 9875874
references.citation: N Engl J Med. 2007 Nov 1;357(18):1799-809
references.pmid: 17878149
references.citation: J Bone Miner Res. 2003 Nov;18(11):1947-54
references.pmid: 14606506