Inadequate osteoporosis treatment persists after major fractures
Only 1 in 10 men and fewer than 2 in 10 women who did not receive osteoporosis therapy at the time of a fracture were prescribed adequate treatment during follow-up, increasing secondary fracture risks for those left untreated, according to an analysis of data from Austria published in Bone.
“The incidence of osteoporotic fractures in Austria is among the highest worldwide,” Oliver Malle, MD, of the division of endocrinology and diabetology at Medical University of Graz, Austria, and colleagues wrote in the study background. “However, so far, no sufficient data has been available on the incidence of osteoporosis treatment in patients suffering an osteoporotic fracture. Furthermore, due to substantial differences in health care systems, results from other countries in which treatment rate after major osteoporotic fractures has been investigated cannot be directly extrapolated to Austria.”
Malle and colleagues analyzed data from 915 adults recruited from eight trauma centers throughout Austria, as part of the International Costs and Utilities Related to Osteoporotic Fractures Study, a prospective observational study assessing data from patients who experienced a major osteoporotic fracture (78.3% women; mean age, 75 years). Researchers stratified participants into two groups: those with osteoporosis treatment at time of fracture (bisphosphonates, estrogens, parathyroid hormone, selective estrogen receptor modulators, or SERMS, and calcitonin) and those without treatment. A first interview was performed during inpatient care or no less than 2 weeks after fracture. Follow-up interviews were performed by phone call at 4, 12 and 18 months after fracture. All fractures were confirmed via X-ray.
Within the cohort, 624 patients (68.2%) were available at 4 months, 552 patients (60.3%) were available at 12 months and 495 patients (54.1%) were available at 18 months after the index fracture.
At the time of fracture, 184 patients (20.1%) received pharmacologic treatment and 731 (79.9%) did not. Compared with those who did not receive osteoporosis treatment, those who did were younger, more likely to have a prevalent fracture, and more likely to show two risk factors for osteoporosis (current corticosteroid therapy and parental history of proximal femur fracture) and intake of analgesic medication.
The researchers also observed large treatment disparities by sex. Among women with no osteoporosis treatment at the time of the index fracture, follow-up analysis revealed an osteoporosis treatment rate of 17.6%, 16% and 15.3% after 4, 12 and 18 months, respectively. Among men, the treatment rate was 8.1%, 12.1% and 10.4% at 4, 12 and 18 months, respectively.
Among participants initially treated for osteoporosis, the treatment rate was 65.4%, 54.2% and 60.4% for women, and 66.9%, 55.1% and 55.2% for men after 4, 12 and 18 months, respectively. At the time of fracture, the most frequently prescribed drugs were bisphosphonates (88%) and SERMs (4.3%). Additionally, osteoporosis treatment was lower among men vs. women 4 months after fracture (8% vs. 17.6%; P = .01).
“In those who did not receive osteoporosis treatment at the time of fracture, only 1 in 10 men and less than 2 in 10 women were prescribed an adequate osteoporosis treatment,” the researchers wrote. “In those who had received osteoporosis treatment at the time of fracture, roughly every second patient was deprived of his/her treatment.”
The researchers noted that the relatively short observation period of 18 months could further overestimate the adherence to osteoporosis treatment, so the treatment rate may decrease even further.
In a consensus statement spearheaded by the American Society for Bone and Mineral Research (ASBMR) and the Center for Medical Technology Policy and reported by Endocrine Today, a coalition of stakeholders wrote this month that older adults who sustain a hip or vertebral fracture should be appropriately evaluated and treated for osteoporosis to reduce the risk for secondary fracture, with clinicians utilizing fracture liaison services and offering pharmacotherapy. The coalition developed 13 recommendations, centered on an “overarching principle” that older adults with a hip or vertebral fracture optimally should be managed in the context of a multidisciplinary clinical system that includes case management, such as a fracture liaison service, to ensure patients are appropriately evaluated and treated. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.