title: Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000-2010.
abstract: The probability of initiating with anti-osteoporosis therapy increased from 7 % in 2000 to 46 % in 2010. This improvement was greater for patients over the age of 75 years. Men, those overweight, having dementia or exposed to antipsychotics, sedatives/hypnotics or opioid analgesics were significantly less likely to receive anti-osteoporosis drugs.
  
  
  BACKGROUND
  The objective of this study was to examine trends and determinants of anti-osteoporosis drug prescribing after hip fracture in the UK between 2000 and 2010.
  
  
  METHODS
  Data were extracted from the UK Clinical Practice Research Datalink for patients ≥50 years who had a first hip fracture between 2000 and 2010 and who did not currently (≤6 months prior) receive anti-osteoporosis drugs (bisphosphonates, strontium ranelate, parathyroid hormone, calcitonin and raloxifene) (n = 27,542). The cumulative incidence probability of being prescribed anti-osteoporosis drugs within 1 year after hip fracture was estimated by Kaplan-Meier life-table analyses. Determinants for treatment initiation were estimated by Cox proportional hazards models.
  
  
  RESULTS
  The probability of being prescribed any anti-osteoporosis drug after hip fracture increased from 7 % in 2000 to 46 % in 2010. This trend was more marked in patients ≥75 years. The increase in prescribing of anti-osteoporosis drugs was complemented by a similar increase in vitamin D/calcium provision. Cumulative incidence of receiving anti-osteoporosis therapy was greater at any given point in time in women (8 % in 2000, 51 % in 2010) compared to men (4 % in 2000, 34 % in 2010). In addition to male gender, multivariable Cox regression identified reduced likelihood of receiving anti-osteoporosis drugs for those being overweight, having dementia and exposed to psychotropic drugs (antipsychotics, sedatives/hypnotics) or opioid analgesics.
  
  
  CONCLUSIONS
  Although the prescribing of anti-osteoporosis drugs after hip fracture has increased substantially since 2000, the overall rate remained inadequate, particularly in men. With the continuing increase in the absolute number of hip fractures, further research should be made into the barriers to optimise osteoporosis management.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Klop
authors.forename: D
authors.initials: D
authors.lastname: Gibson-Smith
authors.forename: P J M
authors.initials: PJ
authors.lastname: Elders
authors.forename: P M J
authors.initials: PM
authors.lastname: Welsing
authors.forename: H G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: T-P
authors.initials: TP
authors.lastname: van Staa
authors.forename: F
authors.initials: F
authors.lastname: de Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000639:trends; D011320:Primary Health Care / Q000379:methods / Q000639:trends; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents