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16-10-2024 | Drug Therapy in the Elderly | Editor's Choice | News

Osteoporosis medication underused after fragility fractures

Author: Lynda Williams

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medwireNews: Less than a third of patients who experience a fragility fracture fill a prescription for osteoporosis medication in the year after injury, warn Canadian researchers.

“Despite well-intentioned systemwide efforts to increase postfracture prescribing, we found that limited progress has been made in closing the osteoporosis care gap,” William Silverstein (University of Toronto, Ontario) and co-authors write in a research letter to JAMA Network Open.

The study included data for 37,874 people aged 66 years or older who were admitted to an Ontario hospital with a first fragility fracture of the hip, pelvis, or vertebrae between 2017 and 2021. The majority (69.1%) were women, the median age was 84 years, and they were treated in a state that offers universal healthcare, the investigators say.

Just 31.3% of the patients filled a prescription for the anti-osteoporosis agents alendronate, risedronate, etidronate, zoledronic acid, denosumab, raloxifene, or teriparatide in the year after discharge from hospital.  “Annual prescription rates were stable during the study interval,” the researchers comment.

Multivariate analysis indicated that women were more likely than men to fill an anti-osteoporosis prescription (hazard ratio [HR]=1.23), as were patients with vertebral versus hip or femur fractures (HR=1.30), and those who were discharged to a rehabilitation hospital or to a nursing home for the first time rather than returning to their own home (HR=1.64 and 1.52, respectively).

Other factors associated with prescription fills included measurement of 25-hydroxyvitamin D3 during hospitalization (HR=1.40), and a bone mineral density test being conducted within 5 years of hospitalization (HR=1.28), whereas an outpatient visit for osteoporosis in the 5 years before hospitalization was not associated with receipt of treatment.

Silverstein et al acknowledge that patient, clinician, and healthcare system factors contribute to the “persistent osteoporosis care gap,” such as concern about rare drug side effects, failure to offer treatment to older patients and those with cognitive issues, fear that prompt antiresorptive therapy may hinder fracture healing, and a “disconnect” between acute and primary care health systems.

“Overall, our findings underscore the need for renewed and expanded health system efforts to improve postfracture prescribing of antiosteoporosis medications, particularly for patients at highest risk of undertreatment,” the researchers conclude.

“These efforts could include implementation of fracture liaison services or multifaceted interventions (patient and clinician education, notifications, and reminders), which have the best evidence for improving prescribing rates.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Netw Open 2024; 7: e2438393

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