Abstract
BackgroundA vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, however, has not been well characterized in postmenopausal women in Asia. The purpose of this study was to characterize patient and health system characteristics associated with the diagnosis and management of osteoporosis among postmenopausal women hospitalized with a fragility fracture in Asia.MethodsPatient surveys and medical charts of postmenopausal women (N=1,122) discharged after a fragility hip fracture from treatment centers in mainland China, Hong Kong, Singapore, South Korea, Malaysia, Taiwan, and Thailand between July 1, 2006 and June 30, 2007 were reviewed for bone mineral density (BMD) measurement, osteoporosis diagnosis, and osteoporosis treatment.ResultsThe mean (SD) age was 72.9 (11.5) years. A BMD measurement was reported by 28.2% of patients, 51.5% were informed that they had osteoporosis, and 33.0% received prescription medications for osteoporosis in the 6 months after discharge. Using multivariate logistic regression analyses, prior history of fracture decreased the odds of a BMD measurement (OR 0.63, 95% CI 0.45-0.88). Having a BMD measurement increased the odds of osteoporosis diagnosis (OR 10.1, 95% CI 6.36-16.0), as did having health insurance (OR 4.95, 95% CI 1.51-16.21 for private insurance with partial self-payment relative to 100% self-payment). A history of fracture was not independently associated with an osteoporosis diagnosis (OR 0.80, 95% CI 0.56-1.15). Younger age reduced the odds of receiving medication for osteoporosis (OR 0.59, 95% CI 0.36-0.96 relative to age ≥65), while having a BMD measurement increased the odds (OR 1.79, 95% CI 1.23-2.61).ConclusionsOsteoporosis diagnosis and treatment in Asian countries were driven by BMD measurement but not by fracture history. Future efforts should emphasize education of general practitioners and patients about the importance of fracture.
Highlights
A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries
26 (2.3%) patients did not answer the question about an osteoporosis diagnosis and were excluded from the analysis
A history of fragility fracture prior to the hip fracture was recorded in 16.1% of patients, 52.9% had hypertension and 29.3% had diabetes
Summary
A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, has not been well characterized in postmenopausal women in Asia. Since prior fracture is a welldocumented risk factor for a future non-vertebral osteoporotic fracture in postmenopausal women in western and Asian countries [9,10,11], it is recommended that after a fragility fracture all postmenopausal women should be evaluated for osteoporosis [12]. Recent studies in western countries indicate that rates of treatment with medications for osteoporosis after a fracture vary widely. In the Netherlands only 19% of women age ≥50 years were treated with medications for osteoporosis in the year after a low-trauma fracture [14] and in Belgium only 6% of postmenopausal women received a bisphosphonate or hormone therapy after a hip fracture [15]
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