Examining the treatment gap and risk of subsequent fractures among females with a fragility fracture in the US Medicare population

Abstract

SummaryOur aim was to evaluate the gap in osteoporosis treatment and the impact of osteoporosis treatment on subsequent fragility fractures. We found osteoporosis medication use lowered risk of subsequent fractures by 21% and that black race, higher CCI scores, dementia, and kidney diseases reduced the likelihood of osteoporosis medication use.IntroductionThe goal of this study was to evaluate the predictors of osteoporosis medication use and compare the risk of fragility fractures within 1 year of a fragility fracture between osteoporosis treated and untreated women.MethodsWe conducted a retrospective, observational cohort study using the national Medicare database. Elderly women (≥65 years) who were hospitalized or had an outpatient/ER service for fragility fracture between January 1, 2011 and December 31, 2011 were included. The outcomes of interest were the correlates of and time-to-osteoporosis medication use and risk of a subsequent fracture within 12 months for treated and untreated women. Cox regression was used to evaluate the predictors of treatment use and the risk of fracture based on treatment status.ResultsWomen (28,722) (27.7%) were treated with osteoporosis medication within 12 months of index fracture, and 74,979 (72.2%) were untreated. A number of patient characteristics were associated with a reduced likelihood of osteoporosis medication use, including black race, higher Charlson comorbidity index scores, presence of dementia, and kidney diseases in the baseline. The predictor most strongly and positively associated with osteoporosis medication use after fracture was osteoporosis medication use before fragility fracture (HR = 7.87; 95% CI 7.67–8.07). After adjusting for baseline characteristics, osteoporosis medication use lowered the risk of subsequent fractures by 21% (HR = 0.79, 95% CI 0.75–0.83) over 12 months compared to women without treatment.ConclusionsDemographics and clinical characteristics were strong predictors of osteoporosis medication use. In the US Medicare population, osteoporosis treatment significantly reduced the risk of fragility fractures.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-017-4072-6) contains supplementary material, which is available to authorized users.

Mortality After Osteoporotic Fractures: What Proportion Is Caused by Fracture and Is Preventable?

“…Investigating the causal pathways by which osteoporotic fractures may lead to preventable mortality is not simply an intellectually interesting exercise. Recent studies have documented persistent undertreatment of those with osteoporosis and recent osteoporotic fractures, declining use of pharmacologic fracture prevention therapies and underappreciation by patients as to why a recent fracture signals that they are at high risk for subsequent fractures and other adverse events . It is important that we establish, as best as we can, the extent and mechanisms by which prevention of fractures may delay mortality.…”

Are we closing the gaps in the management of osteoporosis following fragility fractures of the femur?

“…A recent study also showed that only 27.7% of women were treated with osteoporosis medications after fragility fractures within 12 months of the index fracture, while 72.2% were left untreated. 11–15…”

Effects of 12‐Week Exercise Program on Enzyme Activity of Serum Matrix Metalloproteinase‐9 and Tissue Inhibitor of Metalloproteinase‐1 in Female Patients with Postmenopausal Osteoporosis: A Randomized Control Study

“…In accordance with the current knowledge about the role of MMP-9 in bone remodeling and osteoporosis [3-5, 7, 16], we assumed that the serum level of MMP-9 could serve as an important marker for early assessment of treatment response. During this study, the enzyme activity of serum MMP-9, TIMP-1, as well as MMP-9/TIMP-1 ratio were observed in patients with postmenopausal osteoporosis, before and after prescribing to a 12-week exercise program [1,2,[10][11][12]17].…”

“…ose exercises have an impact on slowing or stopping the loss of bone mass, improving balance, and reducing the risk of fall and fractures [1,10,11]. Weight-bearing exercise and resistance training might have an influence on osteogenesis only if the mechanical stress of long bones is strong enough [12].…”

“…is mechanical stress causes endogenous changes that interfere with bone remodeling, while the mechanical signal is being converted in biochemical signals that regulate bone activity mechanism [1,2,[10][11][12].…”