Abstract
Osteoporotic medication after hip fracture is widely recommended by clinical practice guidelines, and medication adherence is essential to meet clinical trial risk reduction figures in the real world. We assessed primary and secondary non-adherence to osteoporosis medications in patients discharged following a hip fracture and identified factors associated with secondary non-adherence. From a population-based retrospective cohort of 19,405 patients aged 65 years and over discharged from a hip fracture in the region of Valencia (Spain) from January 1, 2008 and June 30, 2012, we followed, over a minimum of 365 days, 4,856 patients with at least one osteoporotic medication prescribed within the first six months after discharge. Less than one third of the patients discharged alive after a hip fracture received osteoporotic treatment. Primary non-adherence among naïve patients was low. However, long-term secondary adherence measured by Proportion of Days Covered with medication (PDC) and persistence was largely suboptimal, with naïve users having worse results than experienced patients. Secondary non-adherence was associated with primary non-adherence and age, dementia or sedative treatments for naïve users and with being male, being older than 85 and having dementia for experienced users. Three quarters of naïve users and two thirds of experienced users had interrupted treatment at 48 months.
Highlights
Osteoporotic fractures commonly occur in three main sites –vertebrae column, wrist and hip– and result in significant reductions in quality of life, disability, morbidity[1,2] and mortality[3], which translate into considerable costs to health care systems[4]
Patients were classified for analysis as naïve or experienced users based on the presence or not of osteoporotic medication within a year before the hip fracture, as evidence suggests that those groups behave differently with regards to adherence
Comorbidities were similar among groups except for diabetes and stroke, which were more prevalent in new users (30.0% and 9.9% in naïve vs. 24.7% and 8.1% in experienced users, respectively) and for osteoporosis (5.5% vs. 27.9%) and rheumatoid arthritis (2.3% vs. 3.6%), which were more prevalent in experienced users
Summary
Osteoporotic fractures ( known as fragility or low-trauma fractures) commonly occur in three main sites –vertebrae column, wrist and hip– and result in significant reductions in quality of life, disability, morbidity[1,2] and mortality[3], which translate into considerable costs to health care systems[4]. Several studies show post-fracture treatment remains suboptimal[10], and only 20% to 30% of patients receive one anti-osteoporosis drug after a hip fracture. Gaining knowledge of the factors associated with medication non-adherence to osteoporotic treatments may allow healthcare organisations to identify non-adherent patients early on and to design personalized interventions to improve their management. The aim of this study is to assess primary and secondary non-adherence to osteoporosis medications in patients discharged after a hip fracture and to identify factors associated with secondary non-adherence
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