Background/Purpose: Current National Osteoporosis Guidelines recommend treatment with an approved osteoporosis medication after hip and vertebral fracture. Only 20% of patients receive osteoporosis therapy after hip fracture. We examined the rates of treatment within 365 days of an osteoporosis medication after hip and vertebrae fracture in a large health care system.

Methods: We evaluated use of anti-osteoporosis medications after fracture by identifying all patients over age 40 who had a hip fracture that was surgically repaired and all vertebral fracture patients undergoing augmentation (kyphoplasty or vertebroplasty) based on administrative billing Common Procedure Terminology (CPT) codes between 2010 and September 2013. These patients were then linked to their electronic medical record (EMR) data. We define the index date as the date of the surgical procedure with patients followed until death, AOM use, or 365 days. AOMs in this analysis are bisphosphonates, denosumab, teriparatide, estrogen, or raloxifene. Dates of medication use are based on start and stop dates in the EMR. Basic demographic variables including age, race, gender, prior AOM use, and site of fracture, were collected from the patients EMR and are presented as mean (standard deviation [SD]) or n (%).We evaluated initiation or continuation of AOM at 90, 180, and 365 days post-index and factors associated with their initiation. Hazard ratios (HR) (95% confidence interval [CI]) were created with cox proportional hazards model and are adjusted for gender, race, age by decade, and site of fracture.

Results: There were 1,352 hip fractures and 296 vertebral fractures undergoing augmentation between January 2010 and December 2012. Mean age was 80.9 (SD 12.7) for hip and 75.0 (SD 12.5) for vertebral fractures. Women were the majority population for both hip (73.1%) and vertebral fractures (72.6%). Caucasians made up the majority of both populations (hip 89.6%; vertebral 92.2%). First event was AOM use for 16.1% (hip: 11.1%, vertebral: 39.2%) and death for 11.3% (hip: 12.5%, vertebral 5.7%) of the population. Prior to index date 24.2% of hip and 40.5% of vertebral fracture patients were prescribed an AOM. AOMs were used at fracture or within 90 days for 12.0%, 13.2%, and 14.6% for hip fracture and 34.5%, 37.8% and 45.3% for vertebral fractures at 90,180 and 365 days respectively. Vertebral fractures were associated with an increased likelihood of AOM treatment by 365 days (HR 3.1; 95% CI 2.4, 4.0), women (79.2% of population) were no more likely to be treated (HR 1.3 95% CI 0.9, 1.8) compared to men, and AOM use prior to fracture was associated with treatment by 365 days (HR 3.6; 95% CI 2.8, 4.7).

Conclusion: Treatment gaps continue to persist for hip fracture patients with 14.6% of patients receiving treatment by 365 days after fracture, and  while only 45.3%% of vertebral fracture patients having augmentation receiving therapy by 365 days. Patients with a vertebral fracture and those who were treated before fracture were more often placed on AOM. Treatment after fracture helps has been demonstrated to reduce the likelihood of additional fractures and interventions are needed to increase treatment rates in these at risk populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-osteoporosis-medication-use-after-hip-or-vertebral-fracture/