title: Osteoporosis management in older patients who experienced a fracture.
abstract: BACKGROUND
  Fractures in older patients are common, morbid, and associated with increased risk of subsequent fractures. Inpatient and outpatient management and treatment of fractures can be costly. With more emphasis placed on quality care for Medicare beneficiaries, we studied if patients were receiving proper screening for osteoporosis and treatment after diagnosis of fracture. This study aims to determine if adequate screening and treatment for osteoporosis occurs in the postfracture period.
  
  
  METHODS
  A retrospective analysis of Medicare beneficiaries aged 67 years or older was gathered from a single institution in both inpatient and outpatient visits. Based on International Classification of Diseases ninth revision codes, primary diagnosis of fractures of neck and trunk, upper limb, and lower limb were obtained in addition to current procedural terminology codes for fracture procedures. We studied patients who had been screened for osteoporosis with a bone mineral study or received osteoporosis treatment after their fracture.
  
  
  RESULTS
  Medicare beneficiaries totaling 1,375 patients were determined to have an inclusion fracture between June 1, 2013 and November 30, 2014. At the time of our analysis on December 1, 2014, 1,219 patients were living and included in the analysis. Of these patients, 256 (21.0%) either received osteoporosis testing with bone mineral density or received treatment for osteoporosis. On sex breakdown, 208/820 (25.4%) females received proper evaluation or treatment of osteoporosis in comparison to 48/399 (12.0%) males. This is in comparison to the Centers for Medicare and Medicaid Services' national average of 19.1% for osteoporosis management in females.
  
  
  CONCLUSIONS
  A minority of studied patients received evaluation or treatment for osteoporosis after their fracture. Postfracture investigation and treatment for osteoporosis in Medicare beneficiaries is inadequate. If improved, Medicare costs could be reduced by prevention of future fractures. Future studies could determine how best to ensure this intervention occurs.
authors: Division of Endocrinology, Metabolism and Genetics, Department of Medicine.
authors: Mark J
authors: MJ
authors: Oertel
authors: Division of Endocrinology, Metabolism and Genetics, Department of Medicine.
authors: Leland
authors: L
authors: Graves
authors: Department of Internal Medicine.
authors: Eyad
authors: E
authors: Al-Hihi
authors: Department of Enterprise Analytics, University of Kansas Medical Center, Kansas City, KS, USA.
authors: Vincent
authors: V
authors: Leonardo
authors: Department of Internal Medicine.
authors: Christina
authors: C
authors: Hopkins
authors: Department of Internal Medicine.
authors: Kristin
authors: K
authors: DeSouza
authors: Division of Endocrinology, Metabolism and Genetics, Department of Medicine.
authors: Rajib K
authors: RK
authors: Bhattacharya
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening; D006278:Medicare; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents
keywords: inpatient management; osteoporosis; post-fracture treatment; postfracture evaluation