Trends in Management of Osteoporosis Following Primary Vertebral Compression Fracture

• Published in: Journal of the Endocrine Society Vol. 7; no. 7; p. bvad085
• Main Authors: Malacon, Karen, Beach, Isidora, Touponse, Gavin, Rangwalla, Taiyeb, Lee, Jennifer, Zygourakis, Corinna
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 05.06.2023
• Subjects: Care and treatment; Clinical; Comorbidity; Fractures; Osteoporosis; Patient compliance; Prescription writing; vertebral compression fracture; medication; osteoporosis; trends
• ISSN: 2472-1972; 2472-1972
• DOI: 10.1210/jendso/bvad085

Abstract Purpose Osteoporosis affects more than 200 million individuals worldwide and predisposes to vertebral compression fractures (VCFs). Given undertreatment of fragility fractures, including VCFs, we investigate current anti-osteoporotic medication prescribing trends. Methods Patients 50 and older with a diagnosis of primary closed thoracolumbar VCF between 2004 and 2019 were identified from the Clinformatics® Data Mart database. Multivariate analysis was performed for demographic and clinical treatment and outcome variables. Results Of 143 081 patients with primary VCFs, 16 780 (11.7%) were started on anti-osteoporotic medication within a year; 126 301 (88.3%) patients were not started on medication. The medication cohort was older (75.4 ± 9.3 vs 74.0 ± 12.3 years, P < .001), had higher Elixhauser Comorbidity Index scores (4.7 ± 6.2 vs 4.3 ± 6.7, P < .001), was more likely to be female (81.1% vs 64.4%, P < .001), and was more likely to have a formal osteoporosis diagnosis (47.8% vs 32.9%) than the group that did not receive medication. Alendronate (63.4%) and calcitonin (27.8%) were the most commonly initiated medications. The proportion of individuals receiving anti-osteoporotic medication within the year following VCF peaked in 2008 (15.2%), then declined until 2012 with a modest increase afterward. Conclusions Osteoporosis remains undertreated after low-energy VCFs. New anti-osteoporotic medication classes have been approved in recent years. Bisphosphonates remain the most prescribed class. Increasing recognition and treatment of osteoporosis is paramount to decreasing the risk of subsequent fractures.