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Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures

Fragility fractures are often sentinel events in documenting new cases of osteoporosis. Numerous analyses have demonstrated low rates of adequate osteoporosis evaluation and treatment following primary fragility fractures. The purpose of this study was to quantify the incidence of primary fragility...

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Autores principales: Ross, Bailey J., Lee, Olivia C., Harris, Mitchel B., Dowd, Thomas C., Savoie, Felix H., Sherman, William F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Bone and Joint Surgery, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202643/
https://www.ncbi.nlm.nih.gov/pubmed/34136740
http://dx.doi.org/10.2106/JBJS.OA.20.00142
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author Ross, Bailey J.
Lee, Olivia C.
Harris, Mitchel B.
Dowd, Thomas C.
Savoie, Felix H.
Sherman, William F.
author_facet Ross, Bailey J.
Lee, Olivia C.
Harris, Mitchel B.
Dowd, Thomas C.
Savoie, Felix H.
Sherman, William F.
author_sort Ross, Bailey J.
collection PubMed
description Fragility fractures are often sentinel events in documenting new cases of osteoporosis. Numerous analyses have demonstrated low rates of adequate osteoporosis evaluation and treatment following primary fragility fractures. The purpose of this study was to quantify the incidence of primary fragility fractures in America and the rates of osteoporosis screening and management before and after fracture. METHODS: A retrospective review of the PearlDiver database was conducted using the International Classification of Diseases, Ninth Revision (ICD-9) and ICD, Tenth Revision (ICD-10) and Current Procedural Terminology codes. Patients who were 60 to 80 years of age and had primary fragility fractures of the hip, wrist, spine, pelvis, humerus, and other unspecified locations were included. The rates of dual x-ray absorptiometry (DXA) screening and osteoporosis pharmacotherapy were assessed for 2 years before and 2 years after the primary fracture. RESULTS: In this study, 48,668 patients with a primary fragility fracture were identified. Within this cohort, 25.8% (12,573 of 48,668) had received osteoporosis screening or treatment in the prior 2 years. In the 36,095 patients with no management before the fracture, 19% (6,799 patients) were diagnosed with osteoporosis and 18.4% (6,653 patients) received a DXA scan and/or filed claims for pharmacotherapy in the following 2 years. Patients with an osteoporosis diagnosis were more likely to receive both types of management (odds ratio [OR], 11.55 [95% confidence (CI), 10.31 to 12.95]), and male patients were less likely to receive both types of management (OR, 0.23 [95% CI, 0.17 to 0.27]). Secondary fragility fractures within the next 2 years were diagnosed in 8.4% (3,038 of 36,095) of patients at a mean of 221 days following the primary fracture. CONCLUSIONS: The rates of appropriate osteoporosis evaluation, diagnosis, and management following primary fragility fractures remain unacceptably low. Less than one-third of patients with primary fragility fractures had been evaluated or treated for osteoporosis in the 2 years prior to fracture. Furthermore, among patients without pre-fracture management, <20% received osteoporosis screening or treatment within the next 2 years. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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spelling pubmed-82026432021-06-15 Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures Ross, Bailey J. Lee, Olivia C. Harris, Mitchel B. Dowd, Thomas C. Savoie, Felix H. Sherman, William F. JB JS Open Access Scientific Articles Fragility fractures are often sentinel events in documenting new cases of osteoporosis. Numerous analyses have demonstrated low rates of adequate osteoporosis evaluation and treatment following primary fragility fractures. The purpose of this study was to quantify the incidence of primary fragility fractures in America and the rates of osteoporosis screening and management before and after fracture. METHODS: A retrospective review of the PearlDiver database was conducted using the International Classification of Diseases, Ninth Revision (ICD-9) and ICD, Tenth Revision (ICD-10) and Current Procedural Terminology codes. Patients who were 60 to 80 years of age and had primary fragility fractures of the hip, wrist, spine, pelvis, humerus, and other unspecified locations were included. The rates of dual x-ray absorptiometry (DXA) screening and osteoporosis pharmacotherapy were assessed for 2 years before and 2 years after the primary fracture. RESULTS: In this study, 48,668 patients with a primary fragility fracture were identified. Within this cohort, 25.8% (12,573 of 48,668) had received osteoporosis screening or treatment in the prior 2 years. In the 36,095 patients with no management before the fracture, 19% (6,799 patients) were diagnosed with osteoporosis and 18.4% (6,653 patients) received a DXA scan and/or filed claims for pharmacotherapy in the following 2 years. Patients with an osteoporosis diagnosis were more likely to receive both types of management (odds ratio [OR], 11.55 [95% confidence (CI), 10.31 to 12.95]), and male patients were less likely to receive both types of management (OR, 0.23 [95% CI, 0.17 to 0.27]). Secondary fragility fractures within the next 2 years were diagnosed in 8.4% (3,038 of 36,095) of patients at a mean of 221 days following the primary fracture. CONCLUSIONS: The rates of appropriate osteoporosis evaluation, diagnosis, and management following primary fragility fractures remain unacceptably low. Less than one-third of patients with primary fragility fractures had been evaluated or treated for osteoporosis in the 2 years prior to fracture. Furthermore, among patients without pre-fracture management, <20% received osteoporosis screening or treatment within the next 2 years. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2021-06-14 /pmc/articles/PMC8202643/ /pubmed/34136740 http://dx.doi.org/10.2106/JBJS.OA.20.00142 Text en Copyright © 2021 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Scientific Articles
Ross, Bailey J.
Lee, Olivia C.
Harris, Mitchel B.
Dowd, Thomas C.
Savoie, Felix H.
Sherman, William F.
Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures
title Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures
title_full Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures
title_fullStr Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures
title_full_unstemmed Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures
title_short Rates of Osteoporosis Management and Secondary Preventative Treatment After Primary Fragility Fractures
title_sort rates of osteoporosis management and secondary preventative treatment after primary fragility fractures
topic Scientific Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202643/
https://www.ncbi.nlm.nih.gov/pubmed/34136740
http://dx.doi.org/10.2106/JBJS.OA.20.00142
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