Undertreatment with anti-osteoporotic drugs after hospitalization for fracture

Abstract

This study assessed the proportion of patients treated with anti-osteoporotic drugs during the 1-year period after hospitalization for a fracture, and the influence of a guideline in the period 1998-2000 on the likelihood of receiving treatment for osteoporosis after a fracture. Patients were assessed retrospectively for anti-osteoporotic drug use during a 1-year period following hospitalization for non-traumatic fracture. The PHARMO system, a population-based database ( n=865,000) containing drug and hospitalization data of community-dwelling inhabitants of defined areas in the Netherlands, was used. The study population comprised 1654 patients age 50 years and over who were admitted to hospital for a fracture resulting from a fall during the period 1998-2000. The treatment rate of newly treated patients and the change in treatment rate throughout the period 1998-2000 were the outcome measures. The majority of these patients were women (73%), and had femur fractures (51%). In total, 247 out of 1654 patients (15%) were prescribed anti-osteoporotic drugs within 1 year after discharge from the hospital. Of these 247 patients, 86 were newly treated, mainly with bisphosphonates in the year after discharge following the fracture, yielding a new treatment rate of 5%. The likelihood of receiving treatment for osteoporosis following fracture did not change with the calendar year of fracture (OR 0.95; 95% CI: 0.68-1.30). The result of this study shows that despite the introduction of an osteoporosis treatment guideline in 1999 recommending treatment for fracture patients, most of the time, fracture patients are not being treated for osteoporosis. Thus, to a large extent, osteoporosis remains under-treated.

Osteoporosis management among residents living in long-term care

“…Use of osteoporosis medications prior to fracture was not included as a predictor in the current study as not all residents included had had a fracture. An increased likelihood of osteoporosis management among females has been reported previously among community-living individuals with fragility fractures [14,[38][39][40][41][42][43], among home care recipients [15] and among LTC residents in the USA [20,21]. Although gender was not a predictor of treatment in the current study, previous studies reporting that osteoporosis tends to be overlooked in males suggest the need to initiate osteoporosis investigation in males as well as females to ensure that at-risk males receive adequate management.…”

Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey

“…In particular, the percentage of hip fracture patients who received prescription for anti-osteoporosis drugs was 19% in the study by Gardner et al [16] and 15% in the study by Panneman et al [17]. A large study carried out in Belgian patients who had sustained hip fracture reported that only 6% received treatment [8].…”

Romosozumab Treatment in Postmenopausal Women with Osteoporosis

“…1,2 Even after a fracture, fewer than 25% of patients receive pharmacologic treatment for osteoporosis. [3][4][5] After the discovery that sclerostin deficiency causes rare genetic conditions that are characterized by high bone mass and resistance to fracture, 6,7 sclerostin became a therapeutic target for the treatment of osteoporosis. Sclerostin, a negative regulator of bone formation that is secreted by osteocytes, 8 inhibits Wnt signaling, down-regulating this stimulus for osteoblast development and function.…”