Antiosteoporosis Medication Fill Rate is Low--Even After Fragility Fractures
—Among nearly 40,000 patients hospitalized for a fragility fracture, less than one-third filled a prescription for antiosteoporosis medication during the year following hospital discharge.
Among older adults with fragility fractures, less than one-third fill prescriptions for antiosteoporosis medication following hospital discharge, a recent study suggests.1
“Failing to provide antiosteoporosis medication following a fragility fracture is termed the osteoporosis care gap,” William K. Silverstein, MD, MSc, Department of Medicine, University of Toronto, Ontario, Canada, and coauthors noted in JAMA Network Open. “We quantified the
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osteoporosis care gap in Ontario, Canada, and identified factors associated with filling a prescription for an antiosteoporosis medication.”
This article, entitled, “Antiosteoporosis medication prescriptions after fragility fractures,” was written by Dr Silverstein and colleagues, and published in October 2024 in JAMA Network Open.
Study design and sample
This was a population-based, retrospective cohort study that identified 69,965 patients aged 66 years or older with an Ontario hospital admission for a hip, pelvis, or vertebral fracture between January 1, 2017, and December 31, 2021.
After excluding patients who filled a prescription for an antiosteoporosis medication in the preceding 12 months, those who had chronic kidney disease, those who died during index hospitalization, those who were discharged to a palliative care unit, those who were diagnosed with a traumatic fracture on index hospitalization, or those with osteonecrosis of the jaw or atypical femur fracture in the preceding 5 years, a total of 37,874 patients (median age, 84 years; 69.1% female) were included. Patients with chronic kidney disease, osteonecrosis of the jaw, atypical femur fractures, or traumatic fractures were identified using previously validated algorithms.
The primary outcome of the study was time to filling an antiosteoporosis medication prescription for alendronate, denosumab, etidronate, raloxifene, risedronate, teriparatide, or zoledronic acid in the year following hospital discharge. Outcomes were censored at 1 year following discharge or at death, whichever occurred first.
Low antiosteoporosis prescription fill rate
In the year following hospital discharge for a fracture, 31.3% of patients (11,853) filled a prescription for an antiosteoporosis drug. There were stable annual prescription rates over time in the study. The most commonly prescribed antiosteoporosis drug was risedronate (n=5677). Filling an antiosteoporosis medication prescription was associated with discharge to a rehabilitation hospital (hazard ratio [HR] 1.64; 95% confidence interval [CI] 1.56–1.72), vertebral fracture (HR 1.30; 95% CI 1.21–1.41), and female sex (HR 1.23; 95% CI 1.17–1.28). (p1/para4)
Conclusions
“In this cohort study of nearly 40,000 older adults with an initial fragility fracture between 2017 and 2021, we found that fewer than one-third filled a prescription for antiosteoporosis medication in the year after hospital discharge,” the authors noted in JAMA Network Open. “We found that limited progress has been made in closing the osteoporosis care gap.
The authors noted that there are many factors associated with the osteoporosis care gap, including patient, clinician, and healthy system factors. Patient factors include nonadherence to recommendations for treatment, lack of knowledge about osteoporosis, and concerns about infrequent drug side effects, such as osteonecrosis of the jaw and atypical femur fractures.
Clinician factors include limited knowledge and familiarity with antiosteoporosis medications, failure to offer medications to appropriate patients, and concerns related to potential adverse effects of early antiresorptive therapy.
Health system factors include a lack of reimbursement for osteoporosis management, a disconnect between primary and acute care, and a lack of clarity regarding jurisdiction for osteoporosis management in hospitalized patients.
This study is limited by the inability to determine whether antiosteoporosis medication prescribing was appropriate or to confirm adherence to antiosteoporosis medications due to the ability to only confirm whether medications were dispensed. Because this study was conducted in a Canadian province with universal access to medical care for patients, the generalizability of these findings may be limited.
“Overall, our findings underscore the need for renewed and expanded health system efforts to improve postfracture prescribing of antiosteoporosis medications, particularly for patients at highest risk of undertreatment,” the authors concluded in JAMA Network Open. “These efforts could include implementation of fracture liaison services or multifaceted interventions (patient and clinician education, notifications, and reminders), which have the best evidence for improving prescribing rates,” the authors wrote.
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