Uptake of preventive care associated with postfracture osteoporosis treatment
A study found that Medicare beneficiaries with a fracture were more likely to receive osteoporosis treatment if they had gotten preventive care like bone density tests, wellness visits, or routine vaccinations.
Older patients who receive preventive care are more likely to be treated for osteoporosis after a fracture, a recent study found.
Researchers performed a retrospective cohort study using a 5% sample of Medicare fee-for-service claims from 2016 to 2021 to determine whether individual and community factors were associated with osteoporosis treatment after a major osteoporotic fracture. Patients were included if they were at least 65 years of age; had a first major fracture of the hip, vertebra, pelvis, humerus, femur, or radius/ulna; and had been enrolled in Medicare for at least 12 months before the fracture occurred. The main outcome was initiation of any osteoporosis medication, defined as bisphosphonates, denosumab, teriparatide, abaloparatide, or romosozumab, within one year after fracture. The results were published by the Journal of General Internal Medicine on Dec. 11.
The study included 55,191 patients, of whom 43,440 (78.7%) were women. Overall, 11.1% of patients received osteoporosis treatment before the index fracture, 9.7% had a diagnosis of osteoporosis, and approximately 30% had a Medicare Annual Wellness Visit within a year of the index fracture. Vertebral fractures were most common, at 39.2%. Among the 40,204 patients who completed one-year follow-up after fracture, 31,180 (77.6%) did not receive osteoporosis treatment beforehand or afterward.
Bone mineral density testing and influenza/pneumococcal vaccine were associated with increased postfracture osteoporosis treatment in both men and women, with hazard ratios of 1.57 (95% CI, 1.28 to 1.94) and 1.15 (95% CI, 1.09 to 1.22), respectively, and 1.28 (95% CI, 1.09 to 1.49) and 1.13 (95% CI, 1.08 to 1.19), respectively. Annual Wellness Visits were associated with increased postfracture treatment only in men (hazard ratio, 1.20 [95% CI, 1.04 to 1.38] vs. 1.02 [95% CI, 0.98 to 1.07] in women). Socioeconomic barriers, such as low income, high poverty, mobile home residence, and lack of insurance, were associated with less chance of postfracture osteoporosis treatment in women but not in men, while antidepressant use and history of falls were associated with less postfracture treatment in both sexes.
Limitations include that some fractures may have been misclassified and that the results are not generalizable to younger populations, the authors noted. They concluded that osteoporosis treatment rates among older adults are low both before and after fracture, particularly among men. While engagement with preventive care was strongly associated with appropriate postfracture treatment, socioeconomic and other barriers may decrease treatment likelihood, they stated.
The findings “underscore the need for targeted strategies to encourage preventive care engagement, address social and psychological barriers, and improve treatment continuity—especially for men and socioeconomically disadvantaged women,” the authors wrote. “Future research should evaluate tailored interventions during the post-fracture period to support recovery and reduce secondary fracture risk.”