Treatment gaps in osteoporosis care following recurrent fractures: a nationwide cohort study

Aim: This nationwide cohort study primarily aimed to descriptively characterize real-world treatment patterns, including treatment initiation, adherence, treatment duration and discontinuation of the first treatment drug, among patients who experienced a recurrent osteoporotic fracture. Materials & methods: This population-based, retrospective cohort study used data from the Health Insurance Review and Assessment Database of South Korea. It included male and female patients aged 55 years and older who experienced a recurrent osteoporotic fracture within 2 years of their index fracture in 2013. Results: The study period was from 1 January 2012 to 31 December 2021, with an outcome assessment period from 1 January 2013 to 31 December 2017. A total of 34,558 patients with recurrent osteoporotic fractures were observed, and just over half (n = 18,462, 53.4%) received osteoporosis medication, with a significant difference in medication rates between males (23.7%) and females (58.8%) (p < 0.001). The estimated median duration of osteoporosis medication was 146 days (interquartile range: 61-365 days). The discontinuation rate of medication within 2 years of follow-up after their recurrent fracture was 80.5%, with the highest discontinuation rate (90.4%) observed among patients taking daily oral bisphosphonate medication. Conclusion: Although patients with recurrent fractures require intensive management, our results showed a significant unmet need in the initiation and persistence of osteoporosis medication. Therefore, it is crucial to establish a strategic treatment approach to address the treatment gap in managing osteoporosis among very high-risk patients. Dataset name: Health Insurance Review and Assessment Database of South Korea.