SUN-373 Addressing the Burden of Hip Fracture in Older Men

Abstract

INTRODUCTION: Men have a lower incidence of hip fracture compared to women. However, hip fractures comprise a greater proportion of overall fractures in men and result in greater morbidity and mortality. In 2015, a new high-risk fracture prevention program was implemented in our medical group, targeting men aged 70-85y with hip, pelvic, humerus, wrist or vertebral fracture for osteoporosis treatment within 6 months of the fracture event. In this study, we examined patient characteristics, site of hip fracture, treatment initiation and time to treatment initiation in men who experienced a hip fracture before and after implementation of this new fracture prevention program.METHODS: This study examines data from 1114 men age 70-85y (81% white race) who experienced a hip fracture during 2013-2014 (N=527) and 2015-2016 (N = 587), based on a principal hospital discharge diagnosis, excluding men who had received osteoporosis treatment in the prior year. Initiation of osteoporosis treatment within 6 months following the hip fracture and time to initiation of osteoporosis treatment (bisphosphonate, teriparatide, denosumab) were examined. The following covariates were ascertained using data from electronic health records and databases: age, race/ethnicity, smoking status, body mass index (BMI), and history of diabetes mellitus with diabetes pharmacotherapy. A Charlson Comorbidity Index was derived using health record data form the prior year. The site of hip fracture was classified as femoral neck or pertrochanter. Subgroups were compared using the Chi-square test.RESULTS: Among the 1114 men with hip fracture (mean age 79 ± 4 years), half (54%) experienced a fracture in the femoral neck and the remainder (46%) in the pertrochanter. Nearly 1 in 5 (17%) men were current smokers, 13% were obese (BMI ≥30 kg/m2), 25% had diabetes mellitus, and 42% had a comorbidity index ≥3. One fourth (24%) had a clinical fracture diagnosed in the past 2 years. Osteoporosis treatment initiation post-hip fracture increased from 16% in 2013-2014 to 29% in 2015-2016 with implementation of the high-risk program targeting men (p<0.01). Time to treatment examination of 2013-2014 vs 2015-2016 revealed that the largest increase in treatment initiation was seen at 2-4 months (4% vs 12%, p<0.01) whereas non-significant differences were seen at ≤2 (7% vs 10%) and 4-6 (4% vs 7%) months following hip fracture.CONCLUSION: Implementing targeted post-hip fracture intervention in men dramatically increased osteoporosis treatment following fracture, with the largest intervention seen 2-4 months after fracture. The high burden of prevalent fractures, smoking, and diabetes highlights the need for post-fracture intervention and counseling for modifiable risk factors.