Secondary fracture prevention with osteoporosis medication after a fragility fracture in Sweden remains low despite new guidelines

Abstract

This national register study investigated osteoporosis medication prescriptions for secondary fracture prevention among older Swedish adults. Although prescription proportions are increasing for both men and women, they remain low, especially among individuals aged 90 and older. Improved Fracture Liaison Services could increase the prescription proportions and should be bolstered.

Purpose: Despite clear guidelines for secondary fracture prevention among older adults, it seems undertreatment persists. We aimed to describe secondary fracture prevention with medical osteoporosis treatment in the older Swedish population. Specifically, how prescription has changed over time and if these patterns differ in sociodemographic subgroups.

Methods: Between 2007 and 2020, osteoporosis medication use was studied among all Swedish residents aged 70 and older who had a fragility fracture in the previous 5 years. Previous fragility fractures were defined as fractures of the humerus, wrist, hip, or vertebrae. Osteoporosis medication was defined as any prescription of bone-enhancing medications (including bisphosphonates and denosumab).

Results: Osteoporosis medication increased over the study period, especially among men. Prescription among individuals 90 + was consistently two- to threefold lower compared to 70-79- and 80-89-year-olds. In 2018-2020, 8-17% of women and 5-9% of men, depending on age, received osteoporosis medication. At the beginning of the study period, women with higher education were more likely to be prescribed osteoporosis medication, though this difference decreased over time. Prescription of vitamin D and/or calcium as the only treatment was more common than osteoporosis medications throughout the study period.

Conclusion: Despite increasing prescription proportions, medical treatment for secondary fracture prevention remains low. In addition, it is more common to be prescribed vitamin D or calcium than osteoporosis medication after a fragility fracture, contrary to current guidelines. These results indicate that there is room for improvement for Fracture Liaison Services in Sweden.

Keywords: Falls; Injuries; National registers; Older adults.

Fig. 1

Time trends per age group in pharmacy-prescribed osteoporosis medication between 2007 and 2020, among women and men with a previous fragility fracture, presented by age group, education level, and cohabitation status

Fig. 2

Proportion of individuals with a previous fragility fracture that during 2007–2020 were prescribed osteoporosis medication, vitamin D/calcium, or estrogen before and after the fracture. Stratified by sex and age groups. (“Osteoporosis medication” could be in combination with medium strength estrogens or vitamin D/calcium, “Estrogens” either only estrogens or in combination with vitamin D/calcium, and “Vitamin D/Calcium” is only vitamin D and/or calcium)