Osteoporosis appears to be poorly treated after fractures

Despite proven benefits, only 22 percent of patients are using medications to reduce their risk of repeat fracture 

Tuesday, September 30, 2003

In a large-scale study of more than 21,000 elderly, researchers at Brigham and Women’s Hospital (BWH) have found that many physicians do not prescribe key osteoporosis medications that help reduce their patient’s risk of repeat fracture.

Hip and wrist factures, suffered by more than 550,000 individuals annually, are a leading cause of hospitalization and death in the elderly. Often one fracture from osteoporosis leads to another, but with the help of medications, this risk can be cut by as much as 60 percent.  However, as outlined in the October issue of The American Journal of Medicine, BWH researchers determined that despite their proven benefits, the majority of fracture patients were not taking osteoporosis medications, even when available at significantly reduced rates.

“Given the availability of effective medications, it seems natural that when patients who have sustained a fracture discuss treatment with their physician, an osteoporosis therapy would be prescribed, ” said Daniel Solomon, MD, MPH, a rheumatologist and epidemiologist at BWH.  “Surprisingly, we found that the vast majority of patients were not taking these medications in the six months after a hip or wrist fracture, two common fractures related to osteoporosis.”

In the United States, one in every three adults 65 years old or older falls each year.  Many falls result in fractures, and one if five people who suffer a hip fracture die within the next 12 months. Overall, patients who sustain a hip or wrist fracture are two to five times more likely to sustain another fracture.

Solomon and colleagues from Harvard Medical School studied 21,192 elderly men and women with either a hip or wrist fracture; in 1996 the data revealed that only 6 percent of participants filled a prescription for an osteoporosis medication in the six months following their fracture. Five years later, the use of medications rose steadily to 22 percent. On average though, the change in osteoporosis prescribing before and after injury was very small. The researchers observed only a 3 percent increase, prompting them to question whether clinicians recognized that a first fracture is a major risk factor for future fractures.

 “It appears that a first-time fracture did not signal a red flag to physicians that their patient was at high risk for another osteoporosis-related fracture,” said Solomon. “Treatment of these patients needs to be a top priority for physicians, especially with the dramatic growth in our aging population.”

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BWH is a 725-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. Internationally recognized as a leading academic health care institution, BWH is committed to excellence in patient care, medical research, and the training and education of health care professionals. The hospital’s preeminence in all aspects of clinical care is coupled with its strength in medical research. A leading recipient of research grants from the National Institutes of Health, BWH conducts internationally acclaimed clinical, basic and epidemiological studies.