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Low Frequency of Treatment of Osteoporosis Among Postmenopausal Women Following a Fracture
Susan E. Andrade, ScD;
Sumit R. Majumdar, MD, MPH;
K. Arnold Chan, MD, ScD;
Diana S. M. Buist, PhD;
Alan S. Go, MD;
Michael Goodman, PhD;
David H. Smith, PhD, MHA;
Richard Platt, MD, MS;
Jerry H. Gurwitz, MD
Arch Intern Med. 2003;163:2052-2057.
Background Osteoporosis is a major cause of morbidity. Treatment of osteoporosis reduces the risk of fracture, particularly for postmenopausal women with a history of fracture.
Methods A retrospective study was conducted using the automated databases of 7 health maintenance organizations to evaluate the use of drugs recommended for secondary prevention of osteoporotic fracture. Women 60 years and older with an inpatient or outpatient diagnostic code for a fracture of the hip, vertebra, or wrist between October 1, 1994, and September 30, 1996, and at least 1 year of continuous enrollment with a drug benefit plan following the date of fracture, were identified. The frequency of use of medications for the treatment of osteoporosis (estrogen replacement therapy, bisphosphonates, and calcitonin) during the 1-year period following the date of the initial fracture was estimated overall and according to patient age, fracture site, and year of fracture.
Results During the study period, 3492 women 60 years and older were diagnosed with a fracture of the hip, vertebra, or wrist, and met the inclusion criteria. Of these patients, 822 (24%) received a drug for osteoporosis treatment during the year following the fracture. The proportion of women receiving treatment for osteoporosis was approximately 2-fold higher among those with a fracture of the vertebra (44%) than among those with a fracture of the hip (21%) or wrist (23%) (P<.001). Of the 2605 women who had not been treated for osteoporosis in the 90 days before a fracture, 14% received treatment for osteoporosis in the year following a fracture. Increasing age was associated with a reduced likelihood of receiving osteoporosis treatment (P<.001).
Conclusions Most of the older women who had experienced a fracture of the hip, vertebra, or wrist did not receive drug treatment for osteoporosis within 1 year following the fracture. Interventions to improve the detection and treatment of osteoporosis in high-risk patients need to be developed.
From the Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester (Drs Andrade and Gurwitz); the Department of Medicine, University of Alberta, Edmonton, Alberta (Dr Majumdar); the Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass (Drs Majumdar and Platt); the Channing Laboratory, Brigham and Women's Hospital, Boston (Drs Chan and Platt); the Department of Epidemiology, Harvard School of Public Health, Boston (Dr Chan); Harvard Pilgrim Health Care, Boston (Dr Platt); the Center for Health Studies, Group Health Cooperative, Seattle, Wash (Dr Buist); the Division of Research, Kaiser Permanente of Northern California, Oakland (Dr Go); HealthPartners Research Foundation, Minneapolis, Minn (Dr Goodman); Kaiser Permanente Northwest, Portland, Ore (Dr Smith); and the HMO Research Network Center for Education and Research in Therapeutics (Drs Andrade, Chan, Go, Goodman, Smith, Platt, and Gurwitz). The authors have no relevant financial interest in this article.
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