Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study

Am J Med. 2015 May;128(5):519-26.e1. doi: 10.1016/j.amjmed.2015.01.014. Epub 2015 Feb 3.


Background: Although current osteoporosis management guidelines recommend use of pharmacologic treatment after hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study was to quantify the use of and adherence to osteoporosis medication after hip fracture in 3 countries with different healthcare systems—the United States, Korea, and Spain.

Methods: In 3 cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year after the hip fracture.

Results: We identified 86,202 patients with a hip fracture: 4704 (US Medicare), 6700 (US commercial), 57,631 (Korea), and 17,167 (Spain). The mean age was 77-83 years, and 74%-78% were women. In the year before the index hip fracture, 16%-18% were taking an osteoporosis medication. Within 3 months after the index hip fracture, 11% (US Medicare), 13% (US commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled ≥1 prescriptions for an osteoporosis medication, the mean PDC in the year after the fracture was 0.70 (US Medicare), 0.67 (US commercial), 0.43 (Korea), and 0.66 (Spain).

Conclusions: Regardless of differences in healthcare delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal, with the PDC <0.70 in all 3 countries.

Keywords: Adherence; Bisphosphonate; Cohort study; Hip fracture; Osteoporotic fracture.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / therapeutic use*
  • Comorbidity
  • Diphosphonates / therapeutic use*
  • Female
  • Hip Fractures / epidemiology
  • Hip Fractures / therapy*
  • Hospitalization
  • Humans
  • Male
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / prevention & control*
  • Republic of Korea / epidemiology
  • Secondary Prevention
  • Spain / epidemiology
  • United States / epidemiology


  • Bone Density Conservation Agents
  • Diphosphonates