Osteoporosis Service Use After Hip Fracture Alarmingly Low in US

Pam Harrison

February 27, 2017

Timely utilization of screening and treatment for osteoporosis following hip fracture is "alarmingly low" among American women 50 years of age and older and is especially poor among elderly women, a new observational study indicates.

"Evidence-based clinical guidelines recommend bone-mass measurement and/or initiation of osteoporosis pharmacotherapies following hip fracture," write Catherine Gillespie, MPH, PhD, AARP Public Policy Institute, Washington, DC, and Pamela Morin, MBA, OptumLabs, Cambridge, Massachusetts, in their paper, published online February 23, 2017 in the Journal of Bone and Mineral Research.

"Despite the fact that osteoporosis is a condition commonly known to impact so many older Americans, patients and providers are not taking the steps necessary to diagnose and treat the condition in one of the highest-risk groups — women who have already experienced hip fractures," they assert.

Their results indicate that receipt of primary care was the strongest and most consistent predictor of osteoporosis assessment or treatment following fracture.

Elderly Women Least Likely to Use Osteoporosis Services

The researchers analyzed OptumLabs Data Warehouse medical and pharmacy claims between 2008 and 2013 to assess trends in the use of services to diagnose and treat osteoporosis in a cohort of women following their first hip fracture.

In total, they identified 8349 women over the age of 50 — more than half of whom were 80 years of age or older — who were covered by either private insurance or a Medicare Advantage plan. None of the women had been previously diagnosed with or treated for osteoporosis.

Prior to their fracture, only 21.9% of the cohort had undergone a bone-density measurement (BDM) scan.

"Overall, very few women in our cohort received recommended postfracture services for the identification and secondary prevention of osteoporosis," Dr Gillespie and Ms Morin observe.

Specially, 17.1% of the cohort availed themselves of the necessary osteoporotic services within 6 months of their fracture while slightly more, at 23.1%, took advantage of postfracture services within 12 months.

Importantly, however, "just 13.0% underwent bone-mass testing within 6 months, 7.2% initiated pharmacotherapy for osteoporosis, and a small percentage did both," they add.

Women covered by commercial insurance were more likely to use recommended osteoporosis services following a hip fracture at 23.2% compared to 16.5% of those covered by a Medicare Advantage plan (< .001).

But history of prior bone scan was not associated with use of osteoporosis-related services within 6 months of a fracture in women aged between 50 to 64 and in those who were 65 to 79 years of age.

Nor did researchers identify any significant difference in the use of osteoporosis-related services by ethnicity.

And looking specifically at women 80 years of age and older, Dr Gillespie and Ms Morin also found this age group of women were one-third less likely to take advantage of osteoporosis-related services than younger women, with only 13.8% of the elderly using recommended services within 6 months of their fracture and only 21.3% doing so within 12 months.

Compared with younger women, this difference was significant at both time points (P < .001).

Primary Care Was Strongest Predictor for Osteoporosis Care

The research showed that getting primary care was "the strongest and most consistent predictor" of women receiving any osteoporosis-related care within 6 months of their first hip fracture (based on a multivariable model), increasing the likelihood that women would undergo screening or receive treatment by nearly twofold.

And as the study authors point out, the use of BMD screening did increase across the years among women 65 years of age and older.

On the other hand, younger women between the ages of 50 and 64 were less likely to undergo BMD screening across the same study period.

"Also worth noting is the apparent downward trend in initiation of osteoporosis drugs following a fracture in our treatment-naïve cohort," Drs Gillespie and Morin write — a finding that has been widely reported elsewhere, as they note.

"Our finding that fewer than one in five women receives recommended osteoporosis care in a timely manner after breaking a hip is alarming," the authors affirm.

"We can do better to minimize these missed opportunities to identify and treat the underlying disease [and in] doing so could prevent future fractures, reduce medical costs, and improve the quality of life of aging Americans suffering from osteoporosis," they conclude.

The authors had no relevant financial relationships.

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J Bone Miner Res. Published online February 23, 2017. Abstract

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