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Observational Study
. 2016 Aug 22:11:1111-6.
doi: 10.2147/CIA.S107720. eCollection 2016.

Osteoporosis management in older patients who experienced a fracture

Mark J Oertel  1 , Leland Graves  1 , Eyad Al-Hihi  2 , Vincent Leonardo  3 , Christina Hopkins  2 , Kristin DeSouza  2 , Rajib K Bhattacharya  1
Affiliations
Observational Study

Osteoporosis management in older patients who experienced a fracture

Mark J Oertel et al. Clin Interv Aging. .

Abstract

Background: Fractures in older patients are common, morbid, and associated with increased risk of subsequent fractures. Inpatient and outpatient management and treatment of fractures can be costly. With more emphasis placed on quality care for Medicare beneficiaries, we studied if patients were receiving proper screening for osteoporosis and treatment after diagnosis of fracture. This study aims to determine if adequate screening and treatment for osteoporosis occurs in the postfracture period.

Methods: A retrospective analysis of Medicare beneficiaries aged 67 years or older was gathered from a single institution in both inpatient and outpatient visits. Based on International Classification of Diseases ninth revision codes, primary diagnosis of fractures of neck and trunk, upper limb, and lower limb were obtained in addition to current procedural terminology codes for fracture procedures. We studied patients who had been screened for osteoporosis with a bone mineral study or received osteoporosis treatment after their fracture.

Results: Medicare beneficiaries totaling 1,375 patients were determined to have an inclusion fracture between June 1, 2013 and November 30, 2014. At the time of our analysis on December 1, 2014, 1,219 patients were living and included in the analysis. Of these patients, 256 (21.0%) either received osteoporosis testing with bone mineral density or received treatment for osteoporosis. On sex breakdown, 208/820 (25.4%) females received proper evaluation or treatment of osteoporosis in comparison to 48/399 (12.0%) males. This is in comparison to the Centers for Medicare and Medicaid Services' national average of 19.1% for osteoporosis management in females.

Conclusion: A minority of studied patients received evaluation or treatment for osteoporosis after their fracture. Postfracture investigation and treatment for osteoporosis in Medicare beneficiaries is inadequate. If improved, Medicare costs could be reduced by prevention of future fractures. Future studies could determine how best to ensure this intervention occurs.

Keywords: inpatient management; osteoporosis; post-fracture treatment; postfracture evaluation.

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Figures

Figure 1
Figure 1
PHM2 – osteoporosis management in older patients, experiencing a fracture from February 02, 2013 to July 31, 2014. Abbreviations: n, number of patients; w/o, without.
Figure 2
Figure 2
PHM2 – osteoporosis management in older patients, experiencing a fracture (top ten treatments) from June 01, 2013 to November 11, 2014. Abbreviation: BMD, bone mineral density.
Figure 3
Figure 3
PHM2 – osteoporosis management in older patients, experiencing a fracture from June 01, 2013 to November 11, 2014. Note: Living female and male at least 67 years old, who suffered a fracture within the 18 months (shown in red and green), and have received bone mineral density testing or osteoporosis medication afterward (shown in green).
See this image and copyright information in PMC

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