Mental disorders and osteoporosis treatment in patients with hip fracture-a Danish population-based cohort study

Using Danish registries, we identified 57,887 patients with hip fracture aged ≥ 65 without recent anti-osteoporosis medication (AOM) and examined whether mental disorders affect AOM initiation after hip fracture. One-year initiation ranged from 6.5 to 17.0% among patients with mental disorders compared to 21% in patients without mental disorder. Initiation remains suboptimal, highlighting required targeted interventions.

To evaluate the impact of mental disorders on the initiation of anti-osteoporosis medication (AOM) following hip fracture.

Using Danish medical registries, we identified patients aged ≥ 65, with no recent AOM use and a first-time hip fracture between 2010 and 2020 (n = 57,887). Mental disorders were categorized using a 10-year history of hospital contacts into no mental disorder, organic mental disorders, substance use, schizophrenic, mood, and anxiety disorders. The outcome was initiation of AOM defined by pharmacy dispensations and hospital treatment codes. Among patients without AOM use in the year prior to hip fracture, 1-year cumulative incidence functions (CIF) with 95% confidence intervals of initiation of AOM with death as a competing risk were calculated. Analyses were conducted overall and stratified by sex, age, previous fractures, somatic comorbidity, mental comorbidity, living arrangement, and calendar year.

The 1 year CIF of initiation of AOM after hip fracture was 20.8% (20.4-21.1) for patients with no mental disorder, 6.5% (6.0-7.1) for organic mental disorders, 17.0% (15.6-18.5) for substance use, 11.5% (9.5-13.8) for schizophrenic disorders, 14.8% (13.8-15.8) for mood, and 16.1% (14.4-17.9) for anxiety disorders. Higher initiation of AOM was seen in patients < 80 years, females, with previous fractures, in patients with less somatic comorbidity and no other mental comorbidities, cohabiting in their own home, and in more recent calendar years.

AOM initiation following hip fracture remains suboptimal. Patients with mental disorders were less likely to initiate AOM after hip fracture, highlighting a persistent gap in secondary fracture prevention among vulnerable populations.