Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study.

Roland Chapurlat,Julie Haesebaert,Guillaume Canat,Susan Jaglal,Marie Viprey,Anne-Marie Schott,Pascal Caillet

doi:10.1371/journal.pone.0143842

Abstract

Treatment initiation rates following fragility fractures have often been reported to be low and in recent years numerous programs have been implemented worldwide to increase them. This study aimed at describing osteoporosis (OP) treatment initiation in a representative sample of women who were hospitalized for a distal forearm fracture (DFF) or proximal humerus fracture (PHF) in 2009–2011 in France. The data source was a nationwide sample of 600,000 individuals, extracted from the French National Insurance Healthcare System database. All women aged 50 years and older who were hospitalized for a DFF or PHF between 2009 and 2011 and who had not received any OP treatment in the preceding 12 months were included in a retrospective cohort study. OP treatments initiated during the year following the fracture were analyzed. From 2009 to 2011, 729 women were hospitalized for a DFF or a PHF and 284 were on OP treatment at the time of the fracture occurrence. Among the 445 women who had no prevalent OP treatment, 131 (29.4%) received supplementation treatment only (vitamin D and/or calcium) and 42 (9.4%) received a pharmacologic OP treatment in the year following their fracture. Pharmacological OP treatments included bisphosphonates (n = 21), strontium ranelate (n = 14), hormone replacement therapy (n = 4), or raloxifene (n = 3). General practitioners prescribed 75% of initial OP treatments. Despite the guidelines published in 2006 and the numerous initiatives to promote post-fracture OP treatment, OP treatment initiation rate in women who were hospitalized for a fragility fracture remained low in 2009–2011 in France.

Highlights

Osteoporosis (OP) is characterized by reduced bone mass and disruption of bone architecture, resulting in increased bone fragility and increased fracture risk [1]
The remaining 445 women who were hospitalized for a distal forearm fracture (DFF) or a Proximal humerus fractures (PHF) from January 1, 2009 to December 31, 2011 without prevalent OP treatment constituted the study population
Among the 445 women who had no treatment at the time of the fracture and constituted the study population, 131 received supplementation treatment only, 42 received a pharmacologic OP treatment, and only 61 had a BMD test in the year following their fracture

Summary

Introduction

Osteoporosis (OP) is characterized by reduced bone mass and disruption of bone architecture, resulting in increased bone fragility and increased fracture risk [1]. Proximal humerus fractures (PHF) are the third most frequent non-vertebral fractures in patients over 65 following wrist and femoral neck fractures [7,8]. It has been shown that a personal history of wrist fracture is a major independent risk factor for a future fragility fracture, and femoral neck fracture [9,10]. The study of Andrade et al [20] conducted in USA in 2003 showed that only 24% of women 60 years of age or older who sustained a fragility fracture underwent initiation of OP treatment with bisphosphonates (BP), hormonal replacement therapy (HRT), or calcitonin in the year following the fracture

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