title: Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study.
abstract: BACKGROUND
  Although current osteoporosis management guidelines recommend use of pharmacologic treatment after hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study was to quantify the use of and adherence to osteoporosis medication after hip fracture in 3 countries with different healthcare systems—the United States, Korea, and Spain.
  
  
  METHODS
  In 3 cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year after the hip fracture.
  
  
  RESULTS
  We identified 86,202 patients with a hip fracture: 4704 (US Medicare), 6700 (US commercial), 57,631 (Korea), and 17,167 (Spain). The mean age was 77-83 years, and 74%-78% were women. In the year before the index hip fracture, 16%-18% were taking an osteoporosis medication. Within 3 months after the index hip fracture, 11% (US Medicare), 13% (US commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled ≥1 prescriptions for an osteoporosis medication, the mean PDC in the year after the fracture was 0.70 (US Medicare), 0.67 (US commercial), 0.43 (Korea), and 0.66 (Spain).
  
  
  CONCLUSIONS
  Regardless of differences in healthcare delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal, with the PDC <0.70 in all 3 countries.
authors: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. Electronic address: skim62@partners.org.
authors: Seoyoung C
authors: SC
authors: Kim
authors: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Mi-Sook
authors: MS
authors: Kim
authors: Health Services Research Unit, Center for Public Health Research, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Valencia, Spain.
authors: Gabriel
authors: G
authors: Sanfélix-Gimeno
authors: Department of Family Medicine, Health Promotion Center, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors: Hong Ji
authors: HJ
authors: Song
authors: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
authors: Jun
authors: J
authors: Liu
authors: Health Services Research Unit, Center for Public Health Research, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Valencia, Spain.
authors: Isabel
authors: I
authors: Hurtado
authors: Health Services Research Unit, Center for Public Health Research, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Valencia, Spain.
authors: Salvador
authors: S
authors: Peiró
authors: Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
authors: Joongyub
authors: J
authors: Lee
authors: Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
authors: Nam-Kyong
authors: NK
authors: Choi
authors: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea; Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
authors: Byung-Joo
authors: BJ
authors: Park
authors: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
authors: Jerry
authors: J
authors: Avorn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015897:Comorbidity; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D056910:Republic of Korea / Q000453:epidemiology; D055502:Secondary Prevention; D013030:Spain / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Adherence; Bisphosphonate; Cohort study; Hip fracture; Osteoporotic fracture