Quality of osteoporosis care of older Medicare recipients with fragility fractures: 2006 to 2010

Abstract

Objectives: To assess uptake of postfracture care guidelines in community-dwelling Medicare recipients with fractures.

Design: Retrospective observational cohort study.

Setting: Claims-based study using U.S. Medicare administrative inpatient, outpatient (2003-2010), and prescription (2006-2010) data.

Participants: Individuals aged 68 and older who survived at least 12 months after a fracture of the hip, radius, or humerus.

Measurements: Poisson regression modeled factors, including participant characteristics, comorbidities and hospital referral region (HRR), associated with bone density testing or osteoporosis pharmacotherapy in the 6 months after fracture. Models were repeated for participants with no osteoporosis care observed before fracture (attention naïve).

Results: In 61,832 individuals with fractures, mean age was 80.6, 87.0% were female, 88.5% were white, 2.6% were black, and 62.1% were attention naïve at the time of fracture; 21.8% received testing, pharmacotherapy, or both in the 6 months after fracture. In adjusted models, factors associated with significantly lower likelihood of receiving this care were black race, male sex, and an upper extremity fracture (vs hip). In models restricted to attention-naïve participants, the same factors were associated with lower relative risk of receiving care. Adjusted HRR-level care rates ranged from 14.7% to 22.9% (10th to 90th percentile). The proportion receiving care increased from 2006 to 2009.

Conclusion: Postfracture osteoporosis care was uncommon, particularly in black and male participants. Care increased over time, but for most, a fracture was insufficient to trigger effective secondary prevention, especially for participants who were not receiving prefracture osteoporosis attention. Clinicians and policy-makers must consider effective remedies to this persistent care gap.

Keywords: Medicare; fragility fracture; osteoporosis.

Figure 1

Proportion of Cohort Receiving Bone Density Testing and/or Osteoporosis Pharmacotherapy Within 6 Months of Fracture by Dartmouth Atlas of Health Care Hospital Referral Region (HRR)