Under-prescribed and underutilized: National trends in osteoporosis medication use after fragility fracture

Fragility fractures are common among older adults with osteoporosis, yet most patients do not receive recommended treatment. Prescribing trends in the US after fragility fractures and patient-level predictors of medication prescription remain unclear. This study evaluates prescribing patterns and predictive factors of osteoporosis medication prescription after fragility fracture to identify gaps in secondary prevention and guide future interventions.

Using a commercial claims database (Merative™ MarketScan®), adult patients over 50 with a new fragility fracture from 2015 to 2022 were retrospectively reviewed. Fragility fractures were defined as hip, vertebral compression (VCF), or distal radius fractures (DRF) without concomitant injuries that would be present in a higher energy mechanism. Patients with prior osteoporosis diagnosis or treatment were excluded. The primary outcome was osteoporosis medication prescription within 90 days post-fracture, categorized as bisphosphonate, non-bisphosphonate antiresorptive, or anabolic agent. Multivariable logistic regression identified factors associated with overall prescription and medication class.

Among 53,679 patients with a fragility fracture (mean age 75.1; 62.3% female), only 7.7% were prescribed osteoporosis medication within 90 days of a fragility fracture. Of those treated, 68.8% received bisphosphonates, 26.4% non-bisphosphonate antiresorptives, and 11.1% anabolic agents. The only anabolic agent prescribed was teriparatide. Osteoporosis medication prescription declined over the study period.

Only 8% of patients with fragility fractures receive osteoporosis medication, with bisphosphonates most commonly prescribed. Anabolic therapies are rarely used, despite evidence supporting their efficacy. Additional resources should be dedicated to improving secondary fracture prevention with pharmacological therapy, particularly among older adults and those with comorbidities.