Highlights
December 2003
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.