Treatment for older men with fractures

Shepherd, Angela J.; Cass, Alvah R.; Ray, L.; Tan, Alai; Wilkinson, Gregg S.

doi:10.1007/s00198-011-1681-3

Cited by 17 publications

(19 citation statements)

References 42 publications

(53 reference statements)

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“…Patients with osteoporosis are at increased risk for fractures especially vertebral, wrist, and hip fractures [ 1 ]. Vertebral fractures (VFs) can easily go undiagnosed as they are clinically silent in two third of the cases.…”

Section: Introductionmentioning

confidence: 99%

Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women

et al. 2015

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BackgroundIt is well established that weight is an important determinant of bone health. Whereas obesity is associated with increased mortality and morbidity from diabetes and cardiovascular diseases, high body weight is widely believed to be associated to hypovitaminosis D and protective against the development of osteoporosis and fracture risk. The objective of the study was to evaluate the effect of BMI on vitamin D status and on densitometric vertebral fractures (VFs) in a large series of asymptomatic women aged over 50 who had a VFA examination during their bone mineral density (BMD) testing.MethodsWe enrolled 429 postmenopausal women (mean age, weight and BMI of 59.5 ± 8.3 (50 to 83) years, 75.8 ± 13.3 (35 to 165) kgs and 29.9 ± 5.2 (14.6 to 50.8) kg/m2, respectively. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. VFs were defined using the Genant semiquantitative (SQ) approach. Clinical risk factors of osteoporosis were collected and 25-hydroxivitamin D was measured using electrochimiluminescence (Roche).ResultsPrevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0 % and 78.1 % respectively. VFs grade 2/3were identified in 76 (17.7 %). Comparison between women according to their BMI showed that obese women had a higher BMD and less proportion of women with osteoporosis and VFs grade 2/3 than lean and overweight women. The prevalence of VFs globally increased with age and as BMI and BMD declined. Stepwise regression analysis showed that the presence of osteoporosis was independently related to BMI and history of fractures while the presence of grade 2/3 VFs was independently related to age, hypovitaminosis D and years of menopause.ConclusionObese women had a higher BMD and lower prevalence of VFs. VFs were significantly related to age, hypovitaminosis D and years since menopause. However, among obese women, prevalence of VFs was increased in osteoporotic women.

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Section: Introductionmentioning

confidence: 99%

Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women

et al. 2015

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“…In the USA, the National Osteoporosis Foundation guidelines recommend consideration of pharmacotherapy after hip or vertebral fracture in post-menopausal women and men 50 years of age and older [5]. Several pharmacologic therapies have proven efficacy for reducing risk of osteoporotic fracture [12, 13]; however, women and men at risk of fracture often do not receive preventive treatment [14, 15]. In many countries, the post-fracture care gap is a problem, as patients with hip or other fractures are often not prescribed osteoporosis therapy [15–20].…”

Section: Introductionmentioning

confidence: 99%

Post-fracture pharmacotherapy for women with osteoporotic fracture: analysis of a managed care population in the USA

et al. 2014

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SummaryPharmacologic therapy is recommended to reduce future fracture risk. We examined osteoporosis medications dispensed to older women after first fracture. Only 23 % received therapy during the first year post-fracture. Prior osteoporosis therapy, a prior osteoporosis diagnosis, and older age were good predictors of post-fracture osteoporosis therapy.IntroductionPharmacologic therapy is recommended after osteoporotic fracture to reduce future fracture risk. The objective of this retrospective study was to examine osteoporosis therapy dispensed to women post-fracture.MethodsWe identified women ≥50 years old in a large administrative claims database from 2003 to mid-2012 who were continuously enrolled 2 years before (baseline) and 1 year after first osteoporotic fracture. Exclusions were Paget’s disease or malignant neoplasm. Pre- and post-fracture osteoporosis therapies (oral and parenteral) were assessed overall and by fracture site.ResultsA total of 47,171 women of mean (SD) age of 63 (10) years were eligible; fractures included 8 % hip, 17 % vertebral, 73 % non-hip/non-vertebral, and 3 % multiple fracture sites. Only 18 % received osteoporosis therapy within 90 days and 23 % within 1 year post-fracture. Overall, 19 % of women had a prior osteoporosis diagnosis; 20 % had received osteoporosis therapy during baseline. Of 37,649 (80 %) women without baseline therapy, only 9 % initiated pharmacologic therapy within 1 year. The adjusted odds ratio (OR) of therapy within 1 year post-fracture was significantly greater for women who had received baseline osteoporosis therapy (versus none) and who had vertebral (OR 12.7, 95 % confidence interval (CI) 11.2–14.5), hip (15.2, 12.5–18.7), or non-hip/non-vertebral fracture (34.4, 31.7–37.3). Other significant predictors included pre-fracture osteoporosis diagnosis (1.6, 1.4–1.7) and older age (OR range, 1.3–1.7). Treatment adherence was significantly better among women with baseline osteoporosis diagnosis.ConclusionsThe substantial post-fracture treatment gap represents an important unmet need for women with osteoporotic fractures. Fracture liaison or adherence programs could lead to improved post-fracture treatment rates.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-014-2827-x) contains supplementary material, which is available to authorized users.

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“…A recent large study that analyzed insurance claims data of more than 1.5 million US women aged 50 years and older found that fewer than 1 in 4 had osteoporosis screening within the most recent 2‐year continuous enrollment period . Osteoporosis screening and treatment rates are even lower for older men in the US . One study found that fewer than 20% of men aged 70 to 75 years received screening with dual‐energy X‐ray absorptiometry (DXA) .…”

Section: Introductionmentioning

confidence: 99%

“…(17) Osteoporosis screening and treatment rates are even lower for older men in the US. (18)(19)(20) One study found that fewer than 20% of men aged 70 to 75 years received screening with dual-energy X-ray absorptiometry (DXA). (18) A large cohort study found that only 15% of men aged 50 years and older underwent diagnostic testing and/or initiated pharmacotherapy within 1 year after a fragility fracture.…”

Section: Introductionmentioning

confidence: 99%

How Can We Improve Osteoporosis Care? A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis

Nayak

Greenspan

2018

Journal of Bone and Mineral Research

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Although osteoporosis affects 10 million people in the United States, screening and treatment rates remain low. We performed a systematic review and meta-analysis of the efficacy of quality improvement strategies to improve osteoporosis screening (bone mineral density [BMD]/dual-energy X-ray absorptiometry [DXA] testing) and/or treatment (pharmacotherapy) initiation rates. We developed broad literature search strategies for PubMed, Embase, and Cochrane Library databases, and applied inclusion/exclusion criteria to select relevant studies. Random-effects meta-analyses were performed for outcomes of BMD/DXA testing and/or osteoporosis treatment. Forty-three randomized clinical studies met inclusion criteria. For increasing BMD/DXA testing in patients with recent or prior fracture, meta-analyses demonstrated several efficacious strategies, including orthopedic surgeon or fracture clinic initiation of osteoporosis evaluation or management (risk difference 44%, 95% confidence interval [CI] 26%-63%), fracture liaison service/case management (risk difference 43%, 95% CI 23%-64%), multifaceted interventions targeting providers and patients (risk difference 24%, 95% CI 15%-32%), and patient education and/or activation (risk difference 16%, 95% CI 6%-26%). For increasing osteoporosis treatment in patients with recent or prior fracture, meta-analyses demonstrated significant efficacy for interventions of fracture liaison service/case management (risk difference 20%, 95% CI 1%-40%) and multifaceted interventions targeting providers and patients (risk difference 12%, 95% CI 6%-17%). The only quality improvement strategy for which meta-analysis findings demonstrated significant improvement of osteoporosis care for patient populations including individuals without prior fracture was patient self-scheduling of DXA plus education, for increasing the outcome of BMD testing (risk difference 13%, 95% CI 7%-18%). The meta-analyses findings were limited by small number of studies in each analysis; high between-study heterogeneity; sensitivity to removal of individual studies; and unclear risk of bias of included studies. Despite the limitations of the current body of evidence, our findings indicate there are several strategies that appear worthwhile to enact to try to improve osteoporosis screening and/or treatment rates. © 2018 American Society for Bone and Mineral Research.

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Treatment for older men with fractures

Abstract: Less than 10% of men received bisphosphonate therapy following a low-impact fracture. Men with a primary physician were more likely to receive bisphosphonate therapy; however, <25% of men were seen by a primary physician.

Cited by 17 publications

References 42 publications

Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women

Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women

Post-fracture pharmacotherapy for women with osteoporotic fracture: analysis of a managed care population in the USA

How Can We Improve Osteoporosis Care? A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis

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