Averting Future Fractures, Osteoporosis After Hip Fracture

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"First fracture events represent key opportunities to identify previously undiagnosed and untreated osteoporosis."
"First fracture events represent key opportunities to identify previously undiagnosed and untreated osteoporosis."

Fewer than 1 in 4 women receive recommended assessment or treatment of osteoporosis within 1 year after hip fracture, according to a study published in the Journal of Bone and Mineral Research.1

"While common, osteoporosis and fragility fracture needn't be an inevitable part of aging," Catherine W. Gillespie, PhD, from the AARP Public Policy Institute in Washington, DC, told Rheumatology Advisor. "First fracture events represent key opportunities to identify previously undiagnosed and untreated osteoporosis, and to intervene to prevent subsequent fractures."

According to national guidelines, after hip fracture, patients should undergo bone mass measurement and, if warranted, pharmacologic treatment for osteoporosis. However, the majority of women in the United States do not receive osteoporosis-related services after their first hip fracture. Only limited data exist regarding patient factors that predict the use of services, and no studies have evaluated adherence to guideline recommendations within the first 6 months after hip fracture.

Dr Gillespie and Pamela E. Morin, from OptumLabs in Cambridge, Massachusetts, investigated the use of health services as part of osteoporosis assessment and treatment within 6 to 12 months after first hip fracture in women ≥50 years old. Patient information was derived from nationwide insurance databases. The study included only women who had not previously been diagnosed with nor received prior treatment for osteoporosis.

The study included data from 8349 women, the majority of whom were ≥80 years old or had ≥5 chronic comorbidities. Only 1 of 5 women had undergone bone mass assessment before their first hip fracture.

After hip fracture, 17.1% and 23.1% of women had received osteoporosis-related services within 6 and 12 months, respectively. Within the first 6 months after fracture, 13.0% of women underwent bone mass measurement and 7.2% started taking medication for osteoporosis; even fewer women used both services.

Approximately 1 in 7 women ≥80 years old used osteoporosis-related services within the first 6 months compared with 1 in 5 women aged 50 to 79 years (P <.001). Over the course of the study, among women aged 65 years or older, rates of bone mass measurement use increased, whereas rates of osteoporosis treatment decreased.

Receiving primary care within 6 months after hip fracture was the most important predictor for use of osteoporosis care.

Summary and Clinical Applicability 

Osteoporosis is a common condition and may initially manifest as hip fracture. However, many women who have had a first hip fracture do not undergo osteoporosis diagnosis and treatment, as recommended by national guidelines. Dr Gillespie and Pamela Morin found that fewer than 1 in 4 women receive osteoporosis care within 12 months after their first hip fracture.

"Although women with a history of hip fracture represent one of the highest-risk groups for subsequent fracture, our findings highlight the fact that patients and providers are not taking the steps necessary to avert future fractures," Dr Gillespie said. "Clearly, more could be done in terms of care coordination, perhaps between the emergency physicians and surgeons who treat the fracture and the primary care providers or other specialists who follow up with osteoporosis screening and/or treatment following discharge."

Study Limitations

Patient data were derived from medical and pharmacy claims, which were made only when procedures were completed and prescriptions were filled and may not capture all referrals and prescriptions that may have been issued.

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Reference

  1. Gillespie CW, Morin PE. 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 [published online February 23, 2017]. J Bone Miner Res. doi: 10.1002/jbmr.3079
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