Predictors of imminent risk of fracture in Medicare-enrolled men and women

SUMMARY: Advancing age, female sex, recent prior fracture and falls, and specific comorbidities and medications contribute to imminent (within 1–2 years) risk of fracture in Medicare enrollees. Clinician awareness of these risk factors and their dynamic nature may lead to improved osteoporosis care for elderly patients. PURPOSE: The burden of osteoporotic fracture disproportionately affects the elderly. Growing awareness that fracture risk can change substantially over time underscores the need to understand risk factors for imminent (within 1–2 years) fracture. This study assessed predictors of imminent risk of fracture in the US Medicare population. METHODS: Administrative claims data from a random sample of Medicare beneficiaries were analyzed for patients aged ≥ 67 years on January 1, 2011 (index date), with continuous coverage between January 1, 2009 and March 31, 2011, excluding patients with non-melanoma cancer or Paget’s disease. Incident osteoporotic fractures were identified during 12 and 24 months post-index. Potential predictors were age, sex, race, history of fracture, history of falls, presence of osteoporosis, cardiovascular diseases, chronic obstructive pulmonary disorder (COPD), mood/anxiety disorders, polyinflammatory conditions, difficulty walking, use of durable medical equipment, ambulance/life support, and pre-index use of osteoporosis medications, steroids, or central nervous system medications. Cox proportional hazards models were used to evaluate predictors of fracture risk in the two follow-up intervals. RESULTS: Among 1,780,451 individuals included (mean age 77.7 years, 66% female), 8.3% had prior fracture and 6.1% had a history of falls. During the 12- and 24-month follow-up periods, 3.0% and 5.4% of patients had an incident osteoporotic fracture, respectively. Imminent risk of fracture increased with older age (double/triple), female sex (> 80%), recent prior fracture (> double) and falls, and specific comorbidities and medications. CONCLUSIONS: Demographics and factors including fall/fracture history, comorbidities, and medications contribute to imminent risk of fracture in elderly patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11657-020-00784-7) contains supplementary material, which is available to authorized users.