Treatment for older men with fractures
Less than 10% of men receive osteoporosis treatment, even after a fracture. A study of 17,683 men revealed that older men, those with spinal fractures, and those taking steroids or antidepressants are more likely to receive treatment after a fracture. Seeing a primary care physician also increases osteoporosis treatment rates.
In 2000, the FDA approved bisphosphonates for the treatment of osteoporosis in men. The purpose of this study is to estimate the frequency of bisphosphonate therapy within 12 months following a fracture and describe patient/physician factors associated with treatment.
Health insurance claims for 17,683 men ≥65 years of age, who had a claim for an incident fracture from 2000 to 2005, were followed for at least 6 months post-fracture for the initiation of treatment with a bisphosphonate. Patient characteristics, diagnostic procedures, therapies, co-morbidities, and provider characteristics were compared for men who received treatment with those who did not.
Eight percent of men (n = 1,434) received bisphosphonate therapy. Overall treatment increased from 7% in 2001 to 9% in 2005 (p < 0.001). Treatment for hip fractures remained at 7% (p = 0.747). Treatment increased with age: 6% in men aged 65–69 compared to 11.6% in men aged 85–89 (p < 0.001). Factors associated with treatment included: diagnosis of osteoporosis (OR = 8.8; 95% CI, 7.7, 10.4), glucocorticoid therapy (OR = 3.2; 95% CI, 2.4, 4.3), bone mineral density measurement (OR = 3.4; 95% CI, 2.9, 4.0), and antidepressant therapy with tricyclics (OR = 2.0; 95% CI, 1.2, 3.5) or selective serotonin reuptake inhibitors (OR = 1.7; 95% CI, 1.3, 2.4). Men with vertebral fractures (OR = 2.2; 95% CI, 1.8, 2.6) and men seen by primary physicians (OR = 2.6; 95% CI, 2.3, 3.1) were more likely to receive treatment.
Less than 10% of men received bisphosphonate therapy following a low-impact fracture. Men with a primary physician were more likely to receive bisphosphonate therapy; however, <25% of men were seen by a primary physician.
KeywordsBisphosphonates Fractures Men Osteoporosis
This study was supported by a grant from the AAFP Foundation Joint Grant Awards Program (grant number: G0811).
Conflicts of interest
- 1.Kanis J, Johnell O, Gullberg B, Allander E, Elfors L, Ranstam J, Dequeker J, Dilsen G, Gennari CLVA, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1999) Risk factors for hip fracture in men from Southern Europe: the MEDOS Study. Osteoporos Int 9:45–54PubMedCrossRefGoogle Scholar
- 2.Hoffenberg R, James O, Brocklehurst J, Green I, Horrocks O, Kanis J, Wald N, MacLellan G, Vickers R, Hibbs P, Halliday N, Pyke D (1989) Fractured neck of femur. Prevention and management. J R Coll Physicians Lond 23:8–12Google Scholar
- 8.US Department of Health and Human Services (2010) Healthy People 2010. http://www.healthypeople.gov/hpscripts/KeywordResult.asp?n270=270&n359=359&Submit=Submit. Accessed 5 May 2011
- 12.Cuddihy M, Amadio P, Melton L (2002) Patient barriers to osteoporosis interventions after fracture. Mayo Clinic Proceedings 77, August 2002Google Scholar
- 17.Favus M (ed) (1999) Primer on the metabolic bone diseases and disorders of mineral metabolism. Lippincott, Williams and Wilkins, PhiladelphiaGoogle Scholar
- 19.Eustice C, Eustice R (2006) The facts of corticosteroids (steroids). http://arthritis.about.com/cs/steroids/a/corticosteroids_2.htm. 2009
- 28.SAS Institute I (2006) SAS/STAT user's guide. SAS Institute Inc., CaryGoogle Scholar
- 44.Murray T (1996) Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis. Can Med Assoc J 155:935–939Google Scholar