title: Utilization of osteoporosis medication after a fragility fracture among elderly Medicare beneficiaries.
abstract: Osteoporosis medications are recommended for elderly patients after a fragility fracture. However, we found substantial under-treatment in the post-fracture year, especially among patients who had not previously received such medications. Improved treatment of elderly patients experiencing fragility fractures is needed.
  
  
  
  Osteoporosis medications are recommended for elderly patients after a fragility fracture, but under-treatment is common. We determined osteoporosis medication use after fragility fractures and examined associated factors.
  
  
  
  Our cohort included elderly (age ≥66 years) Medicare-enrolled patients who sustained fragility fractures January 1, 2008-December 31, 2011. Osteoporosis medication prescriptions were determined in the 12 months after the index fracture. Using multivariate logistic models, we examined the association between post-fracture osteoporosis medication use and predictors.
  
  
  
  Of 145,185 patients with fragility fractures (mean age 80.9 ± 7.8 years; 91.2 % white; 81.3 % female), 29.9 % sustained hip, 31.8 % vertebral, and 38.4 % non-hip-non-vertebral fractures. Overall, 30.4 % of the cohort received an osteoporosis medication in the 12-month post-fracture period. Of patients not receiving an osteoporosis medication in the pre-index period (n = 108,344), 14.9 % of all patients, 16.3 % of women, and 10.3 % of men received one in the post-fracture period. Corresponding values for patients receiving an osteoporosis medication in the pre-index period (n = 36,841) were 76.2, 76.5, and 72.2 %. Odds of post-fracture osteoporosis medication use were 68 % higher for women than for men. Osteoporosis diagnosis (odds ratio, 1.55; P < 0.0001) and bone-mineral-density tests before an index fracture (odds ratio, 1.24; P < 0.001) were associated with post-fracture osteoporosis medication use.
  
  
  
  Less than one third of our cohort received an osteoporosis medication in the post-fracture year, when risk of a second fragility fracture is highest. In those not already previously treated with an osteoporosis medication, only about 1 in 7 patients received treatment.
authors.affiliation: Amgen, Inc., Thousand Oaks, CA, USA. ayusuf01@amgen.com.|College of Pharmacy, University of Minnesota, Minneapolis, MN, USA. ayusuf01@amgen.com.
authors.forename: Akeem A
authors.initials: AA
authors.lastname: Yusuf
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Matlon
authors.affiliation: Amgen, Inc., Thousand Oaks, CA, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Grauer
authors.affiliation: Amgen, Inc., Thousand Oaks, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
authors.affiliation: Amgen, Inc., Thousand Oaks, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Chandler
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Peng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000458:organization & administration / Q000706:statistics & numerical data; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery; D011184:Postoperative Period; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents
keywords: Fragility fracture; Medicare; Osteoporosis; Osteoporosis medication