Spotlight on Research for 2003

December 2003 (historical)

Older Patients With Fractures Underuse Osteoporosis Medications

Roughly 80 percent of older patients with hip or forearm fractures did not fill a prescription for an osteoporosis (OP) medicine in the 6 months after the fracture, according to data from a large-scale study partly funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The results suggest that osteoporosis is not well-treated after a new fracture in older people, and that certain groups, such as men, nonwhites, and those with other medical conditions, are less likely to receive treatment for OP.

Daniel Solomon, M.D., and his colleagues at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, who carried out the study, postulate that many doctors and patients are unaware that fractures are related to osteoporosis, or to an underlying weakness in the bones. "Treatment for all patients after an initial fracture is important," say the authors, "because repeat fractures are relatively common."

The Harvard Medical School researchers examined prescription data from a Pennsylvania pharmaceutical benefits program to find out if selected patients received OP medication before or after a fracture. Of 21,192 study patients with an average age of 82, only 6 percent had filled a prescription in 1995 for any medication used to treat osteoporosis (including hormone replacement therapy) within 6 months of fracture; by 2000, this proportion had increased to 21 percent. The study also showed that younger patients, women and Caucasians were more likely to use OP medication, and that medication use before fracture was the strongest predictor for use afterwards.

The authors also noted only a small increase in medication prescribing between the periods before and after fracture, possibly indicating that health care professionals and patients may not recognize fractures as potential indicators of a need for osteoporosis treatment.

Osteoporosis is a skeletal disorder marked by reduced bone strength that predisposes a person to an increased risk of fractures. In the United States today, 10 million individuals already have OP and 18 million more have low bone mass, placing them at increased risk for the disease. Fractures related to OP, say the authors, result in significant morbidity, mortality and cost.

Other funding sources for this study include the National Institute of Diabetes, Digestive, and Kidney Diseases and the National Center on Minority Health and Health Disparities, which along with NIAMS are parts of the Department of Health and Human Service’s National Institutes of Health, and the Arthritis Foundation.

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The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The NIH Osteoporosis and Related Bone Diseases~National Resource Center, also a part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH), provides patients, health professionals and the public with an important link to resources and information on metabolic bone diseases, including osteoporosis, Paget's disease of the bone, osteogenesis imperfecta, and hyperparathyroidism. Additional information can be found on the Resource Center’s Web site at www.osteo.org.

Solomon DH, et. al. Underuse of osteoporosis medications in elderly patients with fractures. Amer. J. Med 2003;115:398-400.