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Войти в исследования Journal of general internal medicine · 2025
Individual and Community-level Determinants of Osteoporosis Treatment Following Fracture Among Medicare Beneficiaries.
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Wu Hongke, Liu Ye, Zhang Jingyi, Sen Bisakha, Curtis Jeffrey R
Аннотация
BACKGROUND: Despite guideline recommendations, pharmacologic treatment after osteoporotic fracture remains suboptimal.
OBJECTIVE: To identify individual and community factors associated with osteoporosis (OP) treatment after major osteoporotic fracture, and to investigate osteoporosis treatment patterns before and after fracture.
DESIGN: Retrospective cohort study using a 5% random sample of Medicare fee-for-service claims (2016-2021).
PARTICIPANTS: Medicare beneficiaries ≥ 65 years with a first major osteoporotic fracture (hip, vertebral, pelvis, humerus, femur, or radius/ulna) during 2017-2020 and ≥ 12 months of continuous enrollment before the index fracture.
MAIN MEASURES: Primary outcome of interest was the start of any OP medication (bisphosphonates, denosumab, teriparatide, abaloparatide, or romosozumab) within one year after fracture. Key factors included preventive-service use in the prior year, community social determinants of health (SDoH) factors derived by exploratory factor analysis, and individual demographics and comorbidities. Lasso-penalized Cox models selected essential variables and estimated adjusted hazard ratios (HRs).
KEY RESULTS: Only 11.9% of patients were treated before fracture and 77.6% received no treatment both before and after fracture. Preventive services were associated with increased post-fracture OP treatment in both sexes (Wellness visit HR[95%CI] = 1.20[1.04-1.38] in men, 1.02[0.98-1.07] in women, bone mineral density testing HR = 1.57[1.28-1.94] in men, 1.15[1.09-1.22] in women; influenza/pneumococcal vaccination HR = 1.28[1.09-1.49] in men, 1.13[1.08-1.19] in women). A community "socioeconomic barrier" factor (low income, high poverty, high mobile-home residence, uninsured) was associated with decreased post-fracture OP treatment in women (HR = 0.89[0.81-0.98]) but not in men. Antidepressant use and history of falls were associated with decreased post-fracture OP treatment in both sexes.
CONCLUSIONS: OP treatment after fracture remains suboptimal-especially among men-despite clear guidelines. Engagement with preventive care was strongly associated with treatment initiation. Community socioeconomic disadvantage and depression were also important barriers to post-fracture treatment, with sex-specific patterns. Integrating fracture-care pathways into preventive visits and focusing on socioeconomically disadvantaged communities could improve secondary fracture prevention.
OBJECTIVE: To identify individual and community factors associated with osteoporosis (OP) treatment after major osteoporotic fracture, and to investigate osteoporosis treatment patterns before and after fracture.
DESIGN: Retrospective cohort study using a 5% random sample of Medicare fee-for-service claims (2016-2021).
PARTICIPANTS: Medicare beneficiaries ≥ 65 years with a first major osteoporotic fracture (hip, vertebral, pelvis, humerus, femur, or radius/ulna) during 2017-2020 and ≥ 12 months of continuous enrollment before the index fracture.
MAIN MEASURES: Primary outcome of interest was the start of any OP medication (bisphosphonates, denosumab, teriparatide, abaloparatide, or romosozumab) within one year after fracture. Key factors included preventive-service use in the prior year, community social determinants of health (SDoH) factors derived by exploratory factor analysis, and individual demographics and comorbidities. Lasso-penalized Cox models selected essential variables and estimated adjusted hazard ratios (HRs).
KEY RESULTS: Only 11.9% of patients were treated before fracture and 77.6% received no treatment both before and after fracture. Preventive services were associated with increased post-fracture OP treatment in both sexes (Wellness visit HR[95%CI] = 1.20[1.04-1.38] in men, 1.02[0.98-1.07] in women, bone mineral density testing HR = 1.57[1.28-1.94] in men, 1.15[1.09-1.22] in women; influenza/pneumococcal vaccination HR = 1.28[1.09-1.49] in men, 1.13[1.08-1.19] in women). A community "socioeconomic barrier" factor (low income, high poverty, high mobile-home residence, uninsured) was associated with decreased post-fracture OP treatment in women (HR = 0.89[0.81-0.98]) but not in men. Antidepressant use and history of falls were associated with decreased post-fracture OP treatment in both sexes.
CONCLUSIONS: OP treatment after fracture remains suboptimal-especially among men-despite clear guidelines. Engagement with preventive care was strongly associated with treatment initiation. Community socioeconomic disadvantage and depression were also important barriers to post-fracture treatment, with sex-specific patterns. Integrating fracture-care pathways into preventive visits and focusing on socioeconomically disadvantaged communities could improve secondary fracture prevention.