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Testing and treatment for osteoporosis following hip fracture in an integrated U.S. healthcare delivery system

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Abstract

Summary

Older veterans with acute hip fracture do not receive adequate evaluation and treatment for osteoporosis, irrespective of their age and underlying health status.

Introduction

Hip fractures are a serious complication of osteoporosis, leading to high mortality and morbidity. Prior studies have found significant undertreatment of osteoporosis in women with hip fracture. We examined the rate of bone density (BMD) testing and osteoporosis treatment among a predominantly male population hospitalized with hip fractures.

Methods

We conducted a retrospective cohort study of patients age 65 years and older hospitalized in U.S. Department of Veterans Affairs (VA) hospitals with hip fracture (N = 3,347) between 1 October, 2004 and 30 September, 2006. The primary outcome was receipt of BMD testing or initiation of pharmacotherapy within 12 months of fracture.

Results

The mean age of the study population was 79.0 years (SD = 6.7), 96.5% were male, and 83.3% were white. Only 1.2% of hip fracture patients underwent BMD testing and 14.5% received osteoporosis therapy within 12 months of fracture. Among fracture patients with minimal comorbid illness (N = 756) only 1.6% underwent BMD testing and 13.0% received pharmacotherapy. In logistic regression models, treatment rates were higher for women compared to men (odds ratio, 3.30; 95% CI, 2.16–5.04) and lower for blacks compared to whites (odds ratio, 0.67; 95% CI, 0.45–0.99).

Conclusions

Evaluation and treatment of osteoporosis among patients with fractures is suboptimal even in an integrated healthcare delivery system with generous pharmaceutical coverage. This study suggests that the undertreatment of osteoporosis demonstrated in the private sector is also present within the VA.

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Acknowledgments

Dr. Vaughan-Sarrazin is a Research Scientist in the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Medical Center, which is funded through the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. Dr. Cram was supported by a K23 career development award (RR01997201) from the NCRR at the NIH and the Robert Wood Johnson Faculty Scholars Program. He is currently supported by R01 HL085347-01A1 from NHLBI, R01 AG33035 from NIA, and the Department of Veterans Affairs.

Conflicts of interest

All authors took part in the conception and design of the study; analysis and interpretation of data; drafting of the article or revising it critically for important intellectual content and final approval of the version to be published. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, E 426 GH, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    A. Shibli-Rahhal

  2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Administration Medical Center, Iowa City, IA, USA

    M. S. Vaughan-Sarrazin, K. Richardson & P. Cram

  3. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    M. S. Vaughan-Sarrazin & P. Cram

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  1. A. Shibli-Rahhal
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Correspondence to A. Shibli-Rahhal.

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Shibli-Rahhal, A., Vaughan-Sarrazin, M.S., Richardson, K. et al. Testing and treatment for osteoporosis following hip fracture in an integrated U.S. healthcare delivery system. Osteoporos Int 22, 2973–2980 (2011). https://doi.org/10.1007/s00198-011-1536-y

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  • DOI: https://doi.org/10.1007/s00198-011-1536-y

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