Skip to main content

Advertisement

SpringerLink
Log in

Use of anti-osteoporosis medication dispensing by patients with hip fracture: could we do better?

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Although Scandinavian countries have the highest incidence of hip fracture in the world, trends in anti-osteoporosis medication use have not been studied. We found less than one-third of Danish hip fracture patients had dispensing of anti-osteoporosis medication over a 10-year period using routinely collected data from population-based registries.

Introduction

To examine trend in dispensing of anti-osteoporosis medication before and after hip fracture surgery in Denmark over a 10-year period using routinely collected data from population-based registries.

Methods

From the Danish Multidisciplinary Hip Fracture Registry, we included 65,011 patients aged 65 years or older with an incident hip fracture in 2005–2015. We calculated, for each calendar year of hip fracture diagnosis, the prevalence of use of anti-osteoporosis medication (at least one dispensing of bisphosphonates, strontium ranelate, denosumab, selective estrogen receptor modulators, or teriparatide) in the year before and in the year following hip fracture diagnosis. Among those without a dispensing in the year before hip fracture, we computed 1-year cumulative incidence of use following hip fracture. We treated death as a competing risk and stratified the analysis on sex, age, and comorbidity.

Results

The prevalence of use before hip fracture varied between 7 and 12%, increasing slightly from 2005 to 2015. The cumulative incidence of use following hip fracture decreased from 16% in 2005 to 13% in 2010, whereupon it increased to 20%. A similar pattern was seen with each stratum of sex, age groups, and comorbidity. The overall prevalence of use after hip fracture was below 22% in all calendar years.

Conclusions

Less than one-third of hip fracture patients had dispensing of anti-osteoporosis medication up to 1 year after hip fracture. We observed only a slight increase in dispensing after hip fracture over the study period, irrespective of patient sex, age, and comorbidity at the time of hip fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kanis JA, Johnell O, Oden A, de Laet C, Oglesby A, Jönsson B (2002) Intervention thresholds for osteoporosis. Bone 31:26–31

    Article  CAS  PubMed  Google Scholar 

  2. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  PubMed  Google Scholar 

  3. van Geel TA, van Helden S, Geusens PP et al (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102

    Article  PubMed  Google Scholar 

  4. von Friesendorff M, Besjakov J, Akesson K (2008) Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res Off J Am Soc Bone Miner Res 23:1832–1841

    Article  Google Scholar 

  5. Warriner AH, Patkar NM, Yun H, Delzell E (2011) Minor, major, low-trauma, and high-trauma fractures: what are the subsequent fracture risks and how do they vary? Curr Osteoporos Rep 9:122–128

    Article  PubMed  Google Scholar 

  6. Lyles KW, Colon-Emeric CS, Magaziner JS et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809

    Article  CAS  PubMed  Google Scholar 

  7. Desai RJ, Mahesri M, Abdia Y et al (2018) Association of osteoporosis medication use after hip fracture with prevention of subsequent nonvertebral fractures: an instrumental variable analysis. JAMA Netw Open 1:e180826

    Article  PubMed  PubMed Central  Google Scholar 

  8. Elliot-Gibson V, Bogoch ER, Jamal SA et al (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778

    Article  CAS  PubMed  Google Scholar 

  9. Formiga F, Rivera A, Nolla JM, Coscujuela A, Sole A, Pujol R (2005) Failure to treat osteoporosis and the risk of subsequent fractures in elderly patients with previous hip fracture: a five-year retrospective study. Aging Clin Exp Res 17:96–99

    Article  PubMed  Google Scholar 

  10. Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305

    Article  CAS  PubMed  Google Scholar 

  11. Kim SC, Kim MS, Sanfelix-Gimeno G et al (2015) Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study. Am J Med 128:519–26.e1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rabenda V, Vanoverloop J, Fabri V, Mertens R, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2008) Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 90:2142–2148

    Article  PubMed  Google Scholar 

  13. Solomon DH, Morris C, Cheng H, Cabral D, Katz JN, Finkelstein JS, Avorn J (2005) Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 80:194–202

    Article  PubMed  Google Scholar 

  14. Cadarette SM, Katz JN, Brookhart MA et al (2008) Trends in drug prescribing for osteoporosis after hip fracture, 1995-2004. J Rheumatol 35:319–326

    PubMed  Google Scholar 

  15. Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650–657

    Article  PubMed  PubMed Central  Google Scholar 

  16. NICE (2008) Bisphosphonates (alendronate, etidronate, risedronate), selective oestrogen receptor modulators (raloxifene) and parathyroid hormone (teriparatide) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women Technology Appraisal guidance [TA161]. London, National Institute for Health and Care Excellence

  17. Khosla S, Hofbauer LC (2018) Osteoporosis: a roadmap to close the treatment gap. Lancet Diabetes Endocrinol 6:833

    Article  Google Scholar 

  18. Klop C, Gibson-Smith D, Elders PJ et al (2015) Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000-2010. Osteoporos Int 26:1919–1928

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Shah A, Prieto-Alhambra D, Hawley S et al (2017) Geographic variation in secondary fracture prevention after a hip fracture during 1999-2013: a UK study. Osteoporos Int 28:169–178

    Article  CAS  PubMed  Google Scholar 

  20. och Socialstyrelsen S (2012) Öppna Jämförelser av hälso-och sjukvårdens kvalitet och effektivitet

  21. Cauley JA, Chalhoub D, Kassem AM et al (2014) Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10:338–351

    Article  PubMed  Google Scholar 

  22. Rosengren BE, Bjork J, Cooper C et al (2017) Recent hip fracture trends in Sweden and Denmark with age-period-cohort effects. Osteoporos Int 28:139–149

    Article  CAS  PubMed  Google Scholar 

  23. Ryg J (2009) The Frail Hip. A study on the risk of second hip fracture, prevalence of osteoporosis and adherence to treatment in patients with recent hip fracture. Odense, Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet

  24. Lunde A, Tell GS, Pedersen AB et al (2019) The role of comorbidity on mortality after hip fracture: a nationwide Norwegian study of 38,126 women with hip fracture matched to a general population comparison cohort. Am J Epidemiol 188(2):398–407

  25. Pedersen AB, Ehrenstein V, Szepligeti SK et al (2017) Thirty-five-year trends in first-time hospitalization for hip fracture, 1-year mortality, and the prognostic impact of comorbidity: a Danish nationwide cohort study, 1980-2014. Epidemiology 28:898–905

    Article  PubMed  Google Scholar 

  26. Mainz J, Krog BR, Bjornshave B et al (2004) Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project. Int J Qual Health Care 16(Suppl 1):i45–i50

    Article  PubMed  Google Scholar 

  27. Schmidt M, Pedersen L, Sorensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29:541–549

    Article  PubMed  Google Scholar 

  28. Schmidt M, Schmidt SA, Sandegaard JL et al (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490

    Article  PubMed  PubMed Central  Google Scholar 

  29. Johannesdottir SA, Horvath-Puho E, Ehrenstein V et al (2012) Existing data sources for clinical epidemiology: the Danish National Database of Reimbursed Prescriptions. Clin Epidemiol 4:303–313

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Compston JE, McClung MR, Leslie WD (2019) Osteoporosis. Lancet 393:364–376

    Article  CAS  PubMed  Google Scholar 

  32. Regionernes Kliniske Kvalitets Program (2015) De kliniske kvalitetsdatabaser. Aarhus, Regionernes Kliniske Kvalitets Program

  33. Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29:1929–1937

    Article  PubMed  Google Scholar 

  34. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, el Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J, on behalf of the International Task Force on Osteonecrosis of the Jaw (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res Off J Am Soc Bone Miner Res 30:3–23

    Article  Google Scholar 

  35. Suresh E, Pazianas M, Abrahamsen B (2014) Safety issues with bisphosphonate therapy for osteoporosis. Rheumatology (Oxford) 53:19–31

    Article  CAS  Google Scholar 

  36. Hawley S, Leal J, Delmestri A et al (2016) Anti-osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis. J Bone Miner Res 31:2008–2015

    Article  CAS  PubMed  Google Scholar 

  37. de Bruin IJA, Wyers CE, van den Bergh JPW, Geusens PPMM (2017) Fracture liaison services: do they reduce fracture rates? Ther Adv Musculoskelet Dis 9:157–164

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C, FREEDOM Trial (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765

    Article  CAS  PubMed  Google Scholar 

  39. Freemantle N, Satram-Hoang S, Tang ET et al (2012) Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study: a 24-month, randomized, crossover comparison with alendronate in postmenopausal women. Osteoporos Int 23:317–326

    Article  CAS  PubMed  Google Scholar 

  40. Jonsson B, Strom O, Eisman JA et al (2011) Cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 22:967–982

    Article  CAS  PubMed  Google Scholar 

  41. Cauley JA (2017) Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol 29:150–156

    Article  PubMed  Google Scholar 

  42. Wennberg J, McPherson K, Goodman D Small area analysis and the challenge of practice variation. Medical practice variations, vol 2015. Springer, pp 1–25

  43. Johannesdottir SA, Maegbaek ML, Hansen JG et al (2012) Correspondence between general practitioner-reported medication use and timing of prescription dispensation. Clin Epidemiol 4:13–18

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lokkegaard EL, Johnsen SP, Heitmann BL et al (2004) The validity of self-reported use of hormone replacement therapy among Danish nurses. Acta Obstet Gynecol Scand 83:476–481

    Article  PubMed  Google Scholar 

  45. Schneeweiss S, Avorn J (2005) A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 58:323–337

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the staff of the hospital departments caring for patients with hip fracture for their continuous effort and contribution to acquisition of the data in the Danish Multidisciplinary Hip Fracture Registry.

Funding

This work was supported by the Health Research Fund of Central Denmark Region.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark

    P. K. Kristensen, V. Ehrenstein, N. Shetty & A. B. Pedersen

  2. Department of Orthopaedic Surgery, Horsens Regional Hospital, Sundvej 30, DK-8700, Horsens, Denmark

    P. K. Kristensen

  3. Department of Bioscience, Applied Marine Ecology and Modelling, Frederiksborgvej 399, building B1.18, 4000, Roskilde, Denmark

    N. Shetty

Authors
  1. P. K. Kristensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Ehrenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. B. Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PKK and ABP conceived and designed the study. PKK, NS, VE, and ABP analyzed and interpreted the data. PKK drafted the manuscript. PKK, NS, VE, and ABP critically revised the manuscript for important intellectual content. All authors have given the final approval of the version to be submitted.

Corresponding author

Correspondence to P. K. Kristensen.

Ethics declarations

The study was approved by the Danish Data Protection Agency (Aarhus University record number 2016-051-000001).

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kristensen, P.K., Ehrenstein, V., Shetty, N. et al. Use of anti-osteoporosis medication dispensing by patients with hip fracture: could we do better?. Osteoporos Int 30, 1817–1825 (2019). https://doi.org/10.1007/s00198-019-05066-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-019-05066-8

Keywords

Search

Navigation