Background/Purpose: Osteoporosis is associated with significant burden in terms of adverse patient outcomes, mortality, and cost; and is particularly common in the older Medicare population. Approximately a quarter of patients with fractures are male. Emerging evidence suggests worse outcomes related to osteoporotic fractures in male compared to female patients.The objective of this study was to examine baseline characteristics of male Medicare patients who experienced a fragility fracture.

Methods: We studied Medicare fee-for-service (FFS) beneficiaries with a closed fragility (or osteoporosis-related) fracture between 01 January 2010 and 30 September 2014 (identification period). Additional inclusion criteria included age ≥65 years as of the index date, continuous enrollment in Medicare FFS with medical and pharmacy benefits (parts A+B+D-C) for a minimum of one year prior to the index date, through at least 1 month after (i.e. beneficiaries were excluded if they died within 30 days of the index date). Patients with Paget’s disease or malignancy (except for non-melanoma skin cancer) at baseline were excluded. Patients were classified into four cohorts based on the observed diagnoses and/or treatment of osteoporosis at baseline. Diagnoses of osteoporosis could be in any position on any medical claim.

Results: A total of 9,876 beneficiaries met eligibility criteria. Sixty-one percent were ≥75 years of age and 90.3% were white. Fewer than 6% had undergone bone mineral density testing with DXA in the 2 years prior to their fracture. 62.8% had a history of musculoskeletal pain and 48.5% had a history of opioid use 1 year prior to index fracture. The most commonly observed fracture sites were spine (n=3,060; 31.0%), hip (n=2,759; 27.9%), and ankle (n=965; 9.8%). Of all patients with a qualifying fracture, approximately 92.8% (n=9,163) did not have a claim for diagnosis or treatment of osteoporosis at baseline. 2.8% (n=279) were diagnosed but not treated, 2.3% (n=227) were treated but not diagnosed, and only 2.1% (n=207) were diagnosed and treated. There was a trend in declining DXA scans from 2012 to 2014 (65-69 years; 6.3 to 5.5% AND 70-74 years; 4.7 to 4.0%) especially pronounced in the ≥75 age group (6.0 to 4.3%).

Conclusion: Our findings suggest a high level of underdiagnosis and undertreatment of osteoporosis in the older male population who experience fracture. Further documentation of cost of illness following an osteoporosis-related fracture, including identification of drivers of high costs and earlier identification high risk patients who may benefit from more targeted screening and osteoporosis therapies, will be of value.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-older-male-patients-with-a-fragility-fracture/