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Insufficient increase in bone mineral density testing rates and pharmacotherapy after hip fracture in Japan

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Abstract

Introduction

Only a few large-scale studies have examined the care gap in Japan. The present study aims to examine the care gap for secondary fracture prevention.

Materials and methods

Changes in the rates of bone mineral density testing (test rate) and osteoporosis pharmacotherapy administration (treatment rate) before and after hip and vertebral fracture registration were examined based on medical insurance data from the medical care system for elderly individuals in Hokkaido, Japan, issued from July 2013 to December 2018.

Results

The hip fracture group comprised 18,258 women and 4162 men, whereas the vertebral fracture group comprised 34,907 women and 9958 men. Test rates were 0.2% and 1.4% prior to fracture registration (pre-registration) and 19.9% and 40.5% after fracture registration (post-registration) in the hip and vertebral fracture groups, respectively. Moreover, pre-registration treatment rates were 18.3% and 28.2% and post-registration rates were 32.7% and 61.0% in the hip and vertebral fracture groups, respectively. The vertebral fracture group had a significantly higher post-registration test and treatment rates than the hip fracture group. Moreover, the post-registration test and treatment rates in the hip fracture group tended to increase over the years. Both fracture groups showed a tendency for decreased post-registration test and treatment rates as age increased, with lower rates observed among men.

Conclusions

Test and treatment rates after hip fracture registration remain lower compared with those after vertebral fracture registration. To bridge the care gap following fractures, medical professionals need better awareness regarding osteoporosis treatment for hip fractures among elderly individuals and males.

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Acknowledgements

This study did not receive and funding from agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Asahi General Hospital, 477, Tomari, Asahimachi, Shimo-Niikawa-gun, Toyama, 939-0798, Japan

    Shinichi Nakatoh

  2. Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Kenji Fujimori

  3. Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan

    Junko Tamaki

  4. Okimoto Clinic, 185-4, Kubi, Yutaka-machi, Kure-City, Hiroshima, 734-0304, Japan

    Nobukazu Okimoto

  5. Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Sumito Ogawa

  6. Department of Public Health, Kindai University Faculty of Medicine, 377-2, Oono-Higashi, Osaka Sayama City, Osaka, 589-8511, Japan

    Masayuki Iki

Authors
  1. Shinichi Nakatoh
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Contributions

SN: conception and design, analysis and interpretation of data, drafting the article, revising the article critically for important intellectual content, and final approval. KF had full access to all data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. JT, NO, MI, and JO: conception and design, revising the article critically for important intellectual content, and final approval.

Corresponding author

Correspondence to Shinichi Nakatoh.

Ethics declarations

Conflict of interest

S. Nakatoh has received lecture fees from Asahi-Kasei Pharmaceutical Co., Ltd., Pfizer Japan Inc., and Eli Lilly Japan K.K. N. Okimoto has received consulting fees from Asahi-Kasei Pharmaceutical Co., Ltd and Teijin Pharma Ltd. N. Okimoto has received payments for lectures, including speakers’ bureau fees, from Asahi-Kasei Pharmaceutical Co., Ltd., Astellas Pharma Inc., Chugai Pharmaceutical Co., Daiichi-Sankyo Co. Ltd., Eisai Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Ono Pharmaceutical Co., Pfizer Japan Inc., Shionogi and Co., Ltd., Kaken Pharmaceutical Co. Ltd., Hisamitsu Pharmaceutical Co, Inc., and Teijin Pharma Ltd. The other authors have no conflicts of interest.

Ethical approval

The study was conducted according to the principles of the Declaration of Helsinki and approved by the institutional review board of Asahi General Hospital (IRB no. 19-01) and the ethics committee of Tohoku University as “Examination of drug treatment compliance in osteoporosis using electronic claim database” (2018-1-868). This study was a part of the “medical/nursing care information database development project,” in which the National Health Insurance Federation was instructed by the Hokkaido Government to construct the database at Tohoku University. The claim data, which were collected by KF, were provided by the governor with the approval by all municipal governments after anonymization in the National Health Insurance Federation.

Informed consent

The data in this study were completely anonymous; thus, informed consent was not required.

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Nakatoh, S., Fujimori, K., Tamaki, J. et al. Insufficient increase in bone mineral density testing rates and pharmacotherapy after hip fracture in Japan. J Bone Miner Metab 38, 589–596 (2020). https://doi.org/10.1007/s00774-020-01093-2

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  • DOI: https://doi.org/10.1007/s00774-020-01093-2

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