Background/Purpose: Treatment rates with pharmacologic therapy after osteoporotic vertebral fracture are very low in the United States. Underlying causes of these low treatment rates are poorly understood. Poor communication between acute care teams and primary care providers (PCP), a lack of acknowledgement of vertebral compression fracture as an osteoporotic fragility fracture by PCPs, and a reluctance by patients to start therapy due to concerns regarding side effects have been proposed as possible driving factors. The objective of this study was to define major underlying causes of low treatment rates of osteoporosis in patients with clinical vertebral fractures in our community.

Methods: Medical records of 862 patients seen for new-onset clinical vertebral fractures were retrospectively analyzed to determine if a diagnosis of osteoporosis was recognized by the PCP and if appropriate pharmacotherapy was initiated by the PCP once a diagnosis of osteoporosis was recognized. Subsequent PCP visit records were analyzed to determine if patients started therapy once prescribed.

Results: Total of 862 patients were seen at our health system for new clinical vertebral fractures in the year 2020. A majority of these patients (615 =71%) were seen by their PCP for clinic follow-up within six months of the fracture. PCPs recognized occurrence of clinical vertebral compression fracture in the interim and diagnosed patients with osteoporosis in most cases, (595 patients =96%). However, less than half of these patients (254=40%) were started on pharmacologic treatment for osteoporosis by their PCP. Of the patients that were prescribed this treatment, less than half (105 =41%) decided to proceed with this treatment resulting in an overall treatment rate of around 12 percent at six months of follow up.

Conclusion: Despite regular identification of vertebral compression fractures, therapeutic inertia by PCPs and low compliance by patients were the most important factors contributing to low treatment rates for osteoporosis after these clinical vertebral fractures were identified in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/therapeutic-inertia-and-low-patient-compliance-major-contributors-to-low-treatment-rates-in-patients-with-osteoporosis-with-clinical-vertebral-compression-fractures/