Underprescribing of Antifracture Medications Following Non-Traumatic Fracture: A Retrospective Cohort Study

People with non-traumatic fractures typically qualify for antifracture medications to prevent recurrent fractures.

To quantify the current osteoporosis care gap and determine factors that predict prescribing of antifracture medications following hospitalization for non-traumatic fracture.

Retrospective cohort study.

Twenty hospitals from a large US health system.

Patients aged 50 years and older presenting to the emergency department with a non-traumatic hip, pelvic, or vertebral fracture between 2017 and 2023.

In-hospital administration or outpatient prescription fill of antifracture medications within 180 days following hospital discharge. We estimated incident rate ratios (IRRs) using modified Poisson regression with robust standard errors to in order to determine factors associated with antifracture medication initiation.

The cohort included 9849 patients (median (IQR) age, 80 [70-87] years; 68% female) of which 9008 (91.4%) were antifracture medication naïve prior to hospital presentation. Of medication-naïve patients, 510 (5.7%) were prescribed antifracture medications, with 279 (3.1%) initiating treatment as an inpatient and 119 (1.3%) in the 180 days following discharge. Medication classes included bisphosphonate (N = 431, 85%), RANK ligand inhibitors and selective estrogen receptor modulators (N = 56, 11%), and anabolic therapies (N = 21, 4%). Female sex (IRR 1.93; 95% CI 1.41-2.64) and a pre-existing diagnosis of osteoporosis (IRR 1.76, 95% CI 1.47-2.11) were positively associated with medication receipt.

Inability to measure reasons for treatment non-initiation.

This study found very few adults with a non-traumatic fracture received medical treatment for secondary osteoporosis fracture prevention. Expanded quality improvement efforts are needed to close the osteoporosis care gap.