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Women with hip fractures need better follow-up monitoring, management for osteoporosis

Screening and treatment for osteoporosis in postmenopausal women after a hip fracture is alarmingly low, with fewer than one in five women aged 50 years and older utilizing recommended services within 6 months of fracture, according to a recent study.

“Given relatively low population-based screening rates, hip fracture events represent an important opportunity to assess for and treat underlying osteoporosis in an effort to prevent future fractures,” Catherine W. Gillespie, MPH, PhD, and Pamela E. Morin, from the AARP Public Policy Institute and OptumLabs, wrote in Journal of Bone and Mineral Research. “Prior studies have found that most women in the United States are not assessed or treated for osteoporosis following hip fracture… [and] none has assessed adherence to clinical guidelines for the management of women with hip fracture when defined as bone mass measurement and/or initiation of treatment within 6 months of the fracture event.”

More generally, a lack of adherence to was shown in a 2014 study that found infrequent adherence to osteoporosis guidelines regarding calcium, vitamin prescriptions and imaging protocols recommended by the National Osteoporosis Foundation following a distal radial fracture.

In this observational study, researchers determined current patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture using medical and pharmacy claims in the OptumLabs Data Warehouse. They identified 8,349 women who experienced a hip fracture from 2008 to 2013. The women were aged 50 years or older and had no previous history of osteoporosis diagnosis, osteoporosis pharmacotherapy or hip fractures. All were enrolled in either private commercial insurance or Medicare Advantage plans.

The results showed that only 17.1% and 23.1% of participants had evidence of osteoporosis assessment and/or treatment within 6 or 12 months of hip fractures, respectively. Gillespie and Morin found that women aged 80 years and older were one-third less likely to use recommended services within 6 months compared with women aged 50 to 79 years (13.8% vs. 20.8%; P < .001). Among women aged 65 years and older, use of bone mass measurement increased significantly over the study period (P < .001), but declined among those aged 50 to 64 years (P = .02). Comparatively, among women aged 50 to 64 years, rates of osteoporosis pharmacotherapy remained steady (P = .8) while the rates declined among women aged 65 to 79 years (P = .07) and among those aged 80 and above (P = .004).

“Even though osteoporosis is a condition commonly known to impact so many older adults, patients and health care 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,” Gillespie said in the press release. “This work shows that we can do more to minimize the burden of osteoporosis, thereby improving quality of life, among older adults who have experienced a hip fracture. – by Savannah Demko

Disclosure: Gillespie and Morin report no relevant financial disclosures.