Patient and Physician Predictors of Post-Fracture Osteoporosis Management
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Undertreatment of osteoporosis after hip or wrist fracture has been well documented, but the reasons for current patterns of care are poorly understood.
We tested the role of physician and patient characteristics in predicting undertreatment when osteoporosis management was clearly indicated after a hip or wrist fracture in women over age 65.
We assembled a cohort of 9,698 female Medicare beneficiaries aged ≥65 years who experienced hip or wrist fracture between 2000 and 2004 and their prescribing physicians.
The dominant prescriber was identified as the physician prescribing at least 50% of patient prescriptions in the year after the fracture. Multivariate logistic regression estimated the role of physician and patient characteristics on osteoporosis management after hip or wrist fracture.
Patients older than 90 and black patients were less likely to be treated for osteoporosis relative to patients aged 65–69 and white patients. Female providers were more likely to manage osteoporosis. Models including patient characteristics discriminated well between managed and unmanaged patients (C statistic 0.81), while adding physician predictors to the model provided no additional discriminatory ability (C statistic 0.81).
Our findings highlight that osteoporosis management rates are similar across providers, but vary considerably by patient types.
- Burge, R, Dawson-Hughes, B, Solomon, DH, Wong, JB, King, A, Tosteson, A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005 2025. J Bone Miner Res 22: pp. 465-475 CrossRef
- Solomon, DH, Finkelstein, JS, Katz, JN, Mogun, H, Avorn, J (2003) Underuse of osteoporosis medications in elderly patients with fractures. Am J Med 115: pp. 398-400 CrossRef
- Andrade, SE, Majumdar, SR, Chan, KA, Buist, SM, Go, AS, Goodman, M (2003) Low Frequency of Treatment of Osteoporosis Among Postmenopausal Women Following a Fracture. Arch Intern Med 163: pp. 2052-2057 CrossRef
- Choudhry, NK, Fletcher, RH, Soumerai, SB (2005) Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med 142: pp. 260-W-30
- Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289: pp. 3095-3105 CrossRef
- Tu, JV, Austin, PC, Chan, BTB (2001) Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction. JAMA 285: pp. 3116-3122 CrossRef
- Epstein, SA, Gonzales, JJ, Weinfurt, K, Boekeloo, B, Yuan, N, Chase, G (2001) Are psychiatrists’ characteristics related to how they care for depression in the medically Ill?: Results from a National Case-Vignette Survey. Psychosomatics 42: pp. 482-489 CrossRef
- Turchin, A, Shubina, M, Chodos, AH, Einbinder, JS, Pendergrass, ML (2008) Effect of board certification on antihypertensive treatment intensification in patients with diabetes mellitus. Circulation 117: pp. 623-628 CrossRef
- Solomon, DH, Brookhart, MA, Gandhi, TK, Karson, A, Gharib, S, Orav, EJ (2004) Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med 117: pp. 919-924 CrossRef
- Access to osteoporosis treatment is critically linked to access to dual-energy X-ray absorptiometry testing. Med Care 45: pp. 6 CrossRef
- Cadarette SMG, Monique AM, Jaglal SB, Beaton DB, Hawker GA. Access to osteoporosis treatment is critically linked to access to dual-energy X-Ray absorptiometry testing. Med Care. 2007;in press.
- Ray, WA, Griffin, MR, Fought, RL, Adams, ML (1992) Identification of fractures from computerized medicare files. J Clin Epidemiol 45: pp. 703-714 CrossRef
- Choudhry, NK, Soumerai, SB, Normand, S-LT, Ross-Degnan, D, Laupacis, A, Anderson, GM (2006) Warfarin prescribing in atrial fibrillation: the impact of physician, patient, and hospital characteristics. Am J Med 119: pp. 607-615 CrossRef
- Raiford DS, Gutthann SP, Garcia Rodriguez LA. Positive predictive value of ICD-9 codes in the identification of cases of complicated peptic ulcer disease in the Saskatchewan Hospital Automated Database. [Article]. Epidemiology January 1996;7(1):101–104. 1996; 7: 101–04.
- Piccola JE. Prescription drugs for senior citizens. Vol. 10/1/2007. State Senator Jeffrey Piccola, 15th District, PA.
- Measuring Rurality. Washington DC: U.S. Department of Agriculture 2004.
- Solomon, DH, Schneeweiss, S, Glynn, RJ, Levin, R, Avorn, J (2003) Determinants of selective cyclooxygenase-2 inhibitor prescribing: are patient or physician characteristics more important?. Am J Med 115: pp. 715-720 CrossRef
- Hosmer, DaSL (2000) Applied logistic regression. John Wiley and Sons, New York City
- Ko, DT, Mamdani, M, Alter, DA (2004) Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA 291: pp. 1864-1870 CrossRef
- Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine 2002.
- Solomon, D, Polinski, J, Stedman, M, Truppo, C, Breiner, L, Egan, C (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22: pp. 362-367 CrossRef
- Solomon, DH, Katz, JN, Finkelstein, JS, Polinski, JM, Stedman, M, Brookhart, MA (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22: pp. 1808-1815 CrossRef
- Solomon, DH, Morris, C, Hailu, C, Cabral, D, Katz, JN, Finkelstein, JS (2005) Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 80: pp. 194-202 CrossRef
- Macinko, JSBaSL (2007) Quantifying the health benefits of primary care phsycian supply in the United States. Int J Health Serv 37: pp. 16 CrossRef
- Starfield B, Shi L, Grover A, Macinko J. The effects of specialist supply on populations’ health: assessing the evidence. Health Aff. 2005: hlthaff.w5.97.
- Chen, JRS, Wang, Y, Radford, MJ, Krumholz, HM (2006) Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. J Gen Intern Med 21: pp. 7
- Epstein, S (2006) Update of current therapeutic options for the treatment of postmenopausal osteoporosis. Clinical Ther 28: pp. 151-173 CrossRef
- Patient and Physician Predictors of Post-Fracture Osteoporosis Management
Journal of General Internal Medicine
Volume 23, Issue 9 , pp 1447-1451
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- physician characteristics
- patient characteristics
- Industry Sectors
- Author Affiliations
- 2. Joint Committee on Taxation, US Congress, Washington, DC, USA
- 1. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- 3. Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA