An Evaluation of Treatment Patterns for Osteoporosis and Outcomes After a Fragility Fracture in a Real-World Setting

Treatment initiation and persistence after a fragility fracture are critical to reduce the risk of subsequent fractures. The authors evaluated osteoporosis management and outcomes after index fracture.

This retrospective cohort study used real-world data for patients (≥50 years), including pharmacy claims linked to commercial and Medicare medical claims from Symphony Health Patient Source. Osteoporosis management was evaluated for at least 12 months after the first case-qualifying fracture during the identification period and continued until a second fracture or March 31, 2020 (depending on data availability). Secondary fracture incidence was evaluated overall and for subgroups at very high risk.

Of 755,312 eligible patients, the proportion with a claim for bone mineral density testing at 12 months after index fracture was low [64,932 (8.6%)], and 75.3% of those tested were ≥65 years of age. Most patients (88.6%) remained untreated at any time after fracture. Among those treated, most (64.9%) were initially treated with bisphosphonates (oral, 93.7%; IV, 6.3%). Treatment duration and persistence were low for all treatments ranging from 6.5 months with 19.6% persistent for abaloparatide to 11.3 months with 45.0% persistent for denosumab. During follow-up, 13.6% of patients had a secondary fracture at any site, with higher incidence in subgroups considered to be at high risk for fracture than in the overall population.

Low rates of osteoporosis testing and treatment initiation and high secondary fracture rates (particularly among patients at very high risk) highlight the need for better management of patients after a fracture.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.