Bone Abstracts

Osteoporosis is commonly known as the prime risk factor for hip fracture in the elderly. We thus evaluated status and effect of osteoporosis treatment amongst hip fracture patients in a large Austrian cohort.

Retrospectively retrieved pseudonymized invoice data from Austrian social insurance authorities covering roughly 98% of the entire population included 31 548 subjects over 50 years with first hip fractures between July 2008 and December 2010, with follow-up until June 2011. Information on anti-osteoporosis treatment before and after first fracture was available between July 2007 and June 2010 for various drugs including bisphosphonates. χ²-testing and Cox regression analysis were used to identify differences between treatment groups.

Alendronic acid was administered to 10.87% of patients (13.27% women, 10.39% men) before and to 13.34% of patients (15.74% women, 13.43% men) after first fracture. Corresponding figures for the other drugs (overall, women, men; before/after first fracture): ibandronic acid: overall 2.70/4.06%, women 3.39/5.01%, men 0.81/1.46%; risedronic acid: 5.27/3.58%, 6.57/4.42%, 1.70/1.26%; zoledronic acid: 0.34/0.93%, 0.40/1.10%, 0.18/0.48%; calcitonin: 1.98/1.47%, 2.42/1.67%, 0.77/0.90%; treatment frequencies of strontium, raloxifen, teriparatide, PTH, and denosumab were below 1% in all groups. As many as 72.76% of patients (66.97% women, 86.83% men) were untreated. Amongst survivors, we observed a significantly decreased proportion of subsequent fractures when receiving bisphosphonates only before or before and after first fracture, compared with bisphosphonate treatment only after first fracture (χ²=21.841, P<0.0001), the same being true for non-bisphosphonate drugs (χ²=6.269, P<0.05). Moreover, whereas individuals receiving bisphosphonates at least before first fracture showed prolonged survival after hospital discharge relative to untreated patients (HR 0.69, 95% CI: 0.64–0.74; P<0.0001), there was no such difference for other drugs.

Taken together, we observe under-treatment for osteoporosis particularly in the male population. Bisphosphonates significantly contribute to reduction of hip fracture-related mortality and consecutive fracture risk, in particular when prescribed before the first fracture.