Aged; Alendronate/therapeutic use; Belgium/epidemiology; Bone Density Conservation Agents/therapeutic use; Cohort Studies; Databases, Factual; Diphosphonates/therapeutic use; Female; Hip Fractures/epidemiology/therapy; Hospitalization/statistics & numerical data; Humans; Middle Aged; Osteoporosis, Postmenopausal/complications/prevention & control; Patient Compliance/statistics & numerical data; Physician's Practice Patterns/statistics & numerical data; Retrospective Studies; Selective Estrogen Receptor Modulators/therapeutic use
Abstract :
[en] BACKGROUND: Following hip fracture, pharmacologic treatment can reduce the rate of subsequent fragility fractures. The objective of the present study was to assess the proportion of patients who are managed with bisphosphonates or selective estrogen-receptor modulators after hip fracture and to evaluate, among those managed with alendronate, the twelve-month compliance and persistence with treatment. METHODS: Data were gathered from health insurance companies and were collected by AIM (Agence Intermutualiste) for the Belgian National Social Security Institute (INAMI). We selected all postmenopausal women who had been hospitalized for a hip fracture between April 2001 and June 2004 and had not been previously managed with bisphosphonates. Patients who had received alendronate treatment after the hip fracture were categorized according to their formulation use during the follow-up study (daily, weekly, daily followed by weekly, or weekly followed by weekly). Compliance at twelve months was quantified with use of the medication possession ratio (i.e., the number of days of alendronate supplied during the first year of treatment, divided by 365). Persistence with prescribed treatment was calculated as the number of days from the initial prescription to a lapse of more than five weeks after completion of the previous prescription refill. The cumulative treatment persistence rate was determined with use of Kaplan-Meier survival curves. RESULTS: A total of 23,146 patients who had sustained a hip fracture were identified. Of these patients, 6% received treatment during the study period: 4.6% received alendronate, 0.7% received risedronate, and 0.7% received raloxifene. Bisphosphonate treatment was dispensed to 2.6% and 3.6% of the patients within six months and one year after the occurrence of the hip fracture, respectively. Among women who received alendronate daily (n = 124) or weekly (n = 182) and were followed for at least one year after the hip fracture, the twelve-month mean medication possession ratio was 67% (65.9% in the daily group and 67.7% in the weekly group). The analysis of persistence with treatment included a total of 726 patients (142 in the daily group, 261 in the weekly group, and 323 in the switch group). At twelve months, the rate of persistence was 41% and the median duration of persistence was 40.3 weeks. CONCLUSIONS: The vast majority of patients who experience a hip fracture do not take anti-osteoporotic therapy after the fracture. Furthermore, among patients who begin alendronate treatment after the fracture, the adherence to treatment decreases over time and remains suboptimal.
Disciplines :
General & internal medicine
Author, co-author :
Rabenda, Véronique ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Vanoverloop, Johan
Fabri, Valerie
Mertens, Raf
Sumkay, Francois
Vannecke, Carine
Deswaef, Andre
Verpooten, Gert A
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Language :
English
Title :
Low incidence of anti-osteoporosis treatment after hip fracture.
Publication date :
2008
Journal title :
Journal of Bone and Joint Surgery. American Volume
ISSN :
0021-9355
eISSN :
1535-1386
Publisher :
Journal of Bone and Joint Surgery, Boston, United States - Massachusetts
Melton LJ 3rd. Who has osteoporosis? A conflict between clinical and public health perspectives. J Bone Miner Res. 2000;15:2309-14.
Haentjens P, Autier P, Barette M, Boonen S, Belgian Hip Fracture Study Group. The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group. J Bone Joint Surg Am. 2001;83:493-500.
Reginster JY, Gillet P, Gosset C. Secular increase in the incidence of hip fractures in Belgium between 1984 and 1996: need for a concerted public health strategy. Bull World Health Organ. 2001;79:942-6.
Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet. 1999;353:802-5.
Dubey A, Koval KJ, Zuckerman JD. Hip fracture epidemiology: a review. Am J Orthop. 1999;28:497-506.
Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int. 2005;16:229-38.
Melton LJ 3rd, Gabriel SE, Crowson CS, Tosteson AN, Johnell O, Kanis JA. Cost-equivalence of different osteoporotic fractures. Osteoporos Int. 2003;14:383-8.
Goeree R, O'Brien B, Pettitt DB, Cuddy L, Ferraz M, Adachi J. An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can. 1996;18(7 Suppl):15-24.
Papadimitropoulos EA, Coyte PC, Josse RG, Greenwood CE. Current and projected rates of hip fracture in Canada. CMAJ. 1997;157:1357-63.
Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17(5 Suppl):505S-511S.
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7:407-13.
Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989;149:2445-8.
Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12:24-35.
Ribot C, Tremollieres F, Pouilles JM, Albarede JL, Mansat M, Utheza G, Bonneu M, Bonnissent P, Ricoeur C. Risk factors for hip fracture. MEDOS study: results of the Toulouse Centre. Bone. 1993;14 Suppl 1:S77-80.
Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD. Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int. 1993;3:120-6.
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767-73.
Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN. Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol. 1996;144:255-63.
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721-39.
Schroder HM, Petersen KK, Erlandsen M. Occurrence and incidence of the second hip fracture. Clin Orthop Relat Res. 1993;289:166-9.
Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med. 2000;109:326-8.
McLellan AR. Identification and treatment of osteoporosis in fractures. Curr Rheumatol Rep. 2003;5:57-64.
Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344-52.
Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11:83-91.
Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280:2077-82.
Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Glüer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282:637-45. Erratum in: JAMA. 1999;282:2124.
McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Reginster JY; Hip Intervention Program Study Group. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001;344:333-40.
Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med. 1995;333:1437-43.
Prostko M. Meta-analysis of prevention of nonvertebral fractures by alendronate. JAMA. 1997;278:631.
Gardner MJ, Flik KR, Mooar P, Lane JM. Improvement in the undertreatment of osteoporosis following hip fracture. J Bone Joint Surg Am. 2002;84:1342-8.
Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T. Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med. 2003;163:2165-72.
Panneman MJ, Lips P, Sen SS, Herings RM. Undertreatment with antiosteoporotic drugs after hospitalization for fracture. Osteoporos Int. 2004;15:120-4.
Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am. 2000;82:1063-70.
Caro JJ, Ishak KJ, Huybrechts KF, Raggio G, Naujoks C. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int. 2004;15:1003-8.
McCombs JS, Thiebaud P, McLaughlin-Miley C, Shi J. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas. 2004;48:271-87.
Yood RA, Emani S, Reed JI, Lewis BE, Charpentier M, Lydick E. Compliance with pharmacologic therapy for osteoporosis. Osteoporos Int. 2003;14:965-8.
Boonen S, Body JJ, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman JM, Rozenberg S, Reginster JY. Evidence-based guidelines for the treatment of postmenopausal osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int. 2005;16:239-54.
Slemenda C. Prevention of hip fractures: risk factor modification. Am J Med. 1997;103:65S-73S.
National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. http://www.nof.org/professionals/ NOF_Clinicians_Guide.pdf. Accessed 9 May 2008.
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785-95.
Orwig DL, Wehren L, YuYahiro J, Hochberg M, Magaziner J. Treatment of osteoporosis following a hip fracture: sending results of bone densitometry to primary care physicians does not increase use of pharmacologic therapy. J Bone Miner Res. 2001;15:S220.
Simonelli C, Killeen K, Mehle S, Swanson L. Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc. 2002;77:334-8.
Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of osteoporosis in patients with fragility fractures. CMAJ. 2000;163:819-22.
Juby AG, De Geus-Wenceslau CM. Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int. 2002;13:205-10.
Feldstein AC, Nichols GA, Elmer PJ, Smith DH, Aickin M, Herson M. Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment. J Bone Joint Surg Am. 2003;85:2294-302.
Ali NS, Twibell KR. Barriers to osteoporosis prevention in perimenopausal and elderly women. Geriatr Nurs. 1994;15:201-6.
Blalock SJ, Currey SS, DeVellis RF, DeVellis BM, Giorgino KB, Anderson JJ, Dooley MA, Gold DT. Effects of educational materials concerning osteoporosis on women's knowledge, beliefs, and behavior. Am J Health Promot. 2000;14:161-9.
Liel Y, Castel H, Bonneh DY. Impact of subsidizing effective anti-osteoporosis drugs on compliance with management guidelines in patients following low-impact fractures. Osteoporos Int. 2003;14:490-5.
Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21:1074-90.
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50:105-16.
Sikka R, Xia F, Aubert RE. Estimating medication persistency using administrative claims data. Am J Manag Care. 2005;11:449-57.