Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009.
BACKGROUND
Clinical practice recommendations state that patients with fragility fractures should be evaluated for osteoporosis and treated for the disease if it is present. The purpose of this study was to assess osteoporosis evaluation and treatment patterns for patients with fragility fractures and assess whether anti-osteoporosis pharmacotherapy initiated immediately following a fragility fracture is associated with improved adherence to the treatment protocol.


METHODS
This retrospective cohort study involved data from a large commercially insured population seen in the period from 2001 through 2009. Patients were community-dwelling individuals aged fifty years or older who had a new low-energy fracture at the hip, vertebra, wrist, or humerus with no evidence of a fragility fracture, osteoporosis treatment, malignant disease, or Paget disease for twelve months preceding the fracture. Rates of diagnostic testing and pharmacotherapy for osteoporosis within twelve months post-fracture were evaluated. Patients treated with oral bisphosphonates were evaluated to determine whether twelve-month adherence to the treatment protocol differed between those who had initiated therapy sooner (at zero to ninety days) and those who initiated it later (at ninety-one to 365 days) following the fracture.


RESULTS
The 88,571 women and 41,984 men had an average age of 72.3 years and 70.5 years, respectively. Nineteen percent (16,464) of the women and 10% (4014) of the men initiated osteoporosis pharmacotherapy, and 30% (26,481) of the women and 15% (6427) of the men underwent diagnostic testing and/or pharmacotherapy following fracture. Treatment rates were highest following vertebral fracture and lowest following wrist or humeral fracture. Treatment rates significantly decreased over time (from 2001 through 2009). The average twelve-month adherence (medication possession ratio) was 56% and 61% among women and men, respectively. Adherence was similar between patients who had initiated treatment sooner after the fracture and those who had initiated it later after the fracture.


CONCLUSIONS
Clinical guidelines for evaluation and treatment following fragility fracture were met for less than one-third of women and less than one-sixth of men. While primary fracture prevention remains the ideal, secondary prevention is critical and there is a need to reverse the downward trend in adherence to post-fracture guidelines.
Center for Observational Research, Amgen Inc., One Amgen Center Drive, MS 24-2-A, Thousand Oaks, CA 91320.
Akhila
A
Balasubramanian
Children's National Medical Center, Attn: Orthopedics, 111 Michigan Avenue NW, Washington DC 20010.
Laura L
LL
Tosi
Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
Joseph M
JM
Lane
Department of Orthopaedics, University of North Carolina at Chapel Hill School of Medicine, 3147 Bioinformatics Building, Campus Box 7055, Chapel Hill, NC 27599-7055.
Douglas R
DR
Dirschl
Clinical Development, Amgen Inc., One Amgen Center Drive, MS 27-5-A, Thousand Oaks, CA 91320.
Pei-Ran
PR
Ho
Center for Observational Research, Amgen Inc., 1120 Veterans Boulevard, MS ASF2, South San Francisco, CA 94080. E-mail address for C.D. O'Malley: comalley@amgen.com.
Cynthia D
CD
O'Malley
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States; D016903:Drug Monitoring
D050071:Bone Density Conservation Agents