title: Osteoporosis-Related Health Services Utilization Following First Hip Fracture Among a Cohort of Privately-Insured Women in the United States, 2008-2014: An Observational Study.
abstract: Timely identification and treatment of osteoporosis following hip fracture is recommended to mitigate future fracture risk, yet prior work has demonstrated a disconnect between evidence-based recommendations and real-world implementation. We sought to describe contemporary patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture based on medical and pharmacy claims in the OptumLabs™ Data Warehouse. From a national sample, we identified 8349 women aged 50+ years enrolled in private commercial or Medicare Advantage plans with no prior history of osteoporosis diagnosis, osteoporosis pharmacotherapy, or hip fracture who experienced a hip fracture between 2008 and 2013. Just 17.1% and 23.1% of these women had evidence of osteoporosis assessment and/or treatment within 6 or 12 months of their fractures, respectively. Women aged 80+ years were one-third less likely to utilize recommended services within 6 months, compared to those aged 50 to 79 years (13.8% versus 20.8%; p < 0.001). Utilization of bone mass measurement increased significantly among women aged 65+ years over the study period (p < 0.001) while declining among those aged 50 to 64 years (p = 0.2). In contrast, rates of osteoporosis pharmacotherapy remained steady among women aged 50 to 64 years (p = 0.8) yet declined among women aged 65 to 79 years and aged 80+ years (p = 0.07 and p = 0.004, respectively). Accounting for differences in all measured characteristics, receipt of primary care was the strongest and most consistent predictor of osteoporosis assessment or treatment following fracture. © 2017 American Society for Bone and Mineral Research.
authors.affiliation: AARP Public Policy Institute, Washington, DC, USA.|OptumLabs, Cambridge, MA, USA.
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Gillespie
authors.affiliation: AARP Public Policy Institute, Washington, DC, USA.
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Morin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology
keywords: EPIDEMIOLOGY; FRACTURE PREVENTION; HEALTH SERVICES RESEARCH; OSTEOPOROSIS; PRACTICE/POLICY-RELATED ISSUES; SCREENING; THERAPEUTICS