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Treatment for older men with fractures

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Abstract

Summary

Less than 10% of men receive osteoporosis treatment, even after a fracture. A study of 17,683 men revealed that older men, those with spinal fractures, and those taking steroids or antidepressants are more likely to receive treatment after a fracture. Seeing a primary care physician also increases osteoporosis treatment rates.

Introduction

In 2000, the FDA approved bisphosphonates for the treatment of osteoporosis in men. The purpose of this study is to estimate the frequency of bisphosphonate therapy within 12 months following a fracture and describe patient/physician factors associated with treatment.

Methods

Health insurance claims for 17,683 men ≥65 years of age, who had a claim for an incident fracture from 2000 to 2005, were followed for at least 6 months post-fracture for the initiation of treatment with a bisphosphonate. Patient characteristics, diagnostic procedures, therapies, co-morbidities, and provider characteristics were compared for men who received treatment with those who did not.

Results

Eight percent of men (n = 1,434) received bisphosphonate therapy. Overall treatment increased from 7% in 2001 to 9% in 2005 (p < 0.001). Treatment for hip fractures remained at 7% (p = 0.747). Treatment increased with age: 6% in men aged 65–69 compared to 11.6% in men aged 85–89 (p < 0.001). Factors associated with treatment included: diagnosis of osteoporosis (OR = 8.8; 95% CI, 7.7, 10.4), glucocorticoid therapy (OR = 3.2; 95% CI, 2.4, 4.3), bone mineral density measurement (OR = 3.4; 95% CI, 2.9, 4.0), and antidepressant therapy with tricyclics (OR = 2.0; 95% CI, 1.2, 3.5) or selective serotonin reuptake inhibitors (OR = 1.7; 95% CI, 1.3, 2.4). Men with vertebral fractures (OR = 2.2; 95% CI, 1.8, 2.6) and men seen by primary physicians (OR = 2.6; 95% CI, 2.3, 3.1) were more likely to receive treatment.

Conclusions

Less than 10% of men received bisphosphonate therapy following a low-impact fracture. Men with a primary physician were more likely to receive bisphosphonate therapy; however, <25% of men were seen by a primary physician.

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References

  1. Kanis J, Johnell O, Gullberg B, Allander E, Elfors L, Ranstam J, Dequeker J, Dilsen G, Gennari CLVA, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1999) Risk factors for hip fracture in men from Southern Europe: the MEDOS Study. Osteoporos Int 9:45–54

    Article  PubMed  CAS  Google Scholar 

  2. Hoffenberg R, James O, Brocklehurst J, Green I, Horrocks O, Kanis J, Wald N, MacLellan G, Vickers R, Hibbs P, Halliday N, Pyke D (1989) Fractured neck of femur. Prevention and management. J R Coll Physicians Lond 23:8–12

    Google Scholar 

  3. Forsen L, Sogaard A, Meyer H, Edna T, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78

    Article  PubMed  CAS  Google Scholar 

  4. Center J, Nguyen T, Schneider D, Sambrook P, Eisman J (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882

    Article  PubMed  CAS  Google Scholar 

  5. Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Roman L, Pietschmann P, Vandormael K, Lombardi A (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610

    Article  PubMed  CAS  Google Scholar 

  6. Gonnelli S, Cepollaro C, Montagnani AM, Bruni D, Caffarelli C, Breschi M, Gennari L, Gennari C, Nuti R (2003) Alendronate treatment in men with primary osteoporosis: a three year longitudinal study. Calcif Tissue Int 73:133–139

    Article  PubMed  CAS  Google Scholar 

  7. Sato Y, Iwamoto J, Kanoko T, Satoh K (2005) Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke. Arch Intern Med 165:1743–1748

    Article  PubMed  CAS  Google Scholar 

  8. US Department of Health and Human Services (2010) Healthy People 2010. http://www.healthypeople.gov/hpscripts/KeywordResult.asp?n270=270&n359=359&Submit=Submit. Accessed 5 May 2011

  9. Kamel H, Mohammad S, Tariq S, Perry HI, Morley J (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 109:326–328

    Article  PubMed  CAS  Google Scholar 

  10. Kiebzak G, Beinart G, Perser K, Ambrose C, Siff S, Heggeness M (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162:2217–2222

    Article  PubMed  Google Scholar 

  11. Feldstein A, Nichols G, Orwoll E, Elmer P, Smith D, Herson M, Aickin M (2005) The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int 16:953–962

    Article  PubMed  Google Scholar 

  12. Cuddihy M, Amadio P, Melton L (2002) Patient barriers to osteoporosis interventions after fracture. Mayo Clinic Proceedings 77, August 2002

  13. Seeley D, Browner W, Nevitt M, Genant H, Scott J, Cummings S (1991) Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med 115:837–842

    PubMed  CAS  Google Scholar 

  14. Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  15. Deyo R, Cherkin D, Ciol M (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  PubMed  CAS  Google Scholar 

  16. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J, Saunders L, Beck C, Feasby T, Ghali W (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  PubMed  Google Scholar 

  17. Favus M (ed) (1999) Primer on the metabolic bone diseases and disorders of mineral metabolism. Lippincott, Williams and Wilkins, Philadelphia

    Google Scholar 

  18. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum 44:1496–1503

    Article  Google Scholar 

  19. Eustice C, Eustice R (2006) The facts of corticosteroids (steroids). http://arthritis.about.com/cs/steroids/a/corticosteroids_2.htm. 2009

  20. Bolton J, Metge C, Lix L, Prior H, Sareen J, Leslie W (2008) Fracture risk from psychotropic medications. J Clin Psychopharmacol 28:384–391

    Article  PubMed  Google Scholar 

  21. Lewis C, Ewing S, Taylor B, Shikany J, Fink H, Ensrud K, Barrett-Connor E, Cummings S, Orwoll E (2007) Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res 22:211–219

    Article  PubMed  Google Scholar 

  22. Richards J, Papaioannou A, Adachi J, Joseph L, Whitson H, Prior J, Goltzman D (2007) Effect of selective serotonin reuptake inibitors on the risk of fracture. Arch Intern Med 167:188–194

    Article  PubMed  CAS  Google Scholar 

  23. Vestergaard P, Rejnmark L, Mosekilde L (2006) Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int 17:807–816

    Article  PubMed  CAS  Google Scholar 

  24. Vestergaard P, Rejnmark L, Mosekilde L (2008) Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcif Tissue Int 82:92–101

    Article  PubMed  CAS  Google Scholar 

  25. Ziere G, Dieleman J, van der Cammen T, Hofman A, Pols H, Stricker B (2008) Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. J Clin Psychopharmacol 28:411–417

    Article  PubMed  CAS  Google Scholar 

  26. Armitage P (1955) Tests for linear trends in proportions and frequencies. Biometrics 11:375–386

    Article  Google Scholar 

  27. Cochran W (1954) Some methods for strengthening the common chi-square tests. Biometrics 10:417–451

    Article  Google Scholar 

  28. SAS Institute I (2006) SAS/STAT user's guide. SAS Institute Inc., Cary

    Google Scholar 

  29. Colon-Emeric C, Sloane R, Hawkes W, Magaziner J, Zimmerman S, Pieper C, Lyles K (2000) The risk of subsequent fractures in community-dwelling men and male veterans with hip fracture. Am J Med 109:324–326

    Article  PubMed  CAS  Google Scholar 

  30. Cummings S, Nevitt M, Browner W, Stone K, Fox K, Ensrud K, Cauley J, Black D, Vogt T (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773

    Article  PubMed  CAS  Google Scholar 

  31. Freedman K, Kaplan F, Bilker W, Strom B, Lowe R (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82-A:1063–1070

    PubMed  CAS  Google Scholar 

  32. Johansson C, Mellstrom D (1996) An earlier fracture risk factor for new fracture and its association with smoking and menopausal age in women. Maturitas 24:97–106

    Article  PubMed  CAS  Google Scholar 

  33. Klotzbuecher C, Ross P, Landsman P, Abbott T III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    Article  PubMed  CAS  Google Scholar 

  34. Mallmin H, Ljunghal S, Persson I, Naessen T, Krusemo U, Bergstrom R (1993) Fracture of the distal forearm as a forecaster of subsequesnt hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 52:269–272

    Article  PubMed  CAS  Google Scholar 

  35. Owen R, Melton L III, Ilstrup D, Riggs B (1982) Colles' fracture and subsequent hip fracture risk. Clin Orthop 171:37–43

    PubMed  Google Scholar 

  36. Ringe J, Dorst A, Faber H, Ibach K (2004) Alendronate treatment of established primary osteoporosis in men: 3-year results of a prospective, comparative, two-arm study. Rheumatol Int 24:110–113

    Article  PubMed  CAS  Google Scholar 

  37. Juby A, De Geus-Wenceslau C (2002) Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 13:205–210

    Article  PubMed  CAS  Google Scholar 

  38. Sato Y, Honda Y, Iwamoto J (2007) Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinsons disease. Neurology 68:911–915

    Article  PubMed  CAS  Google Scholar 

  39. Solomon D, Morris C, Cheng H, Cabral D, Katz J, Finkelstein J, Avorn J (2005) Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 80:194–202

    Article  PubMed  Google Scholar 

  40. Chapuy M, Arlot M, Duboeuf F, Brun J, Crouzet B, Arnold S, Delmas P, Meunier P (1992) Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 327:1637–1642

    Article  PubMed  CAS  Google Scholar 

  41. Dawson-Hughes B, Harris S, Krall E, Dallal G (1997) Effect of calcium and vitamin D. Supplement on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676

    Article  PubMed  CAS  Google Scholar 

  42. Kaufman J (1995) Role of calcium and vitamin D in the prevention and the treatment of postmenopausal osteoporosis: an overview. Clin Rheumatol 14:9–13

    Article  PubMed  Google Scholar 

  43. Kaufman J, Devogelaer J, Raeman F, Rozenberg S, Body J, Westhovens R, Reginster J (1996) Prevention and treatment of postmenopausal osteoporosis. National Consensus of the “Belgian bone Club”. Clin Rheumatol 16:343–345

    Article  Google Scholar 

  44. Murray T (1996) Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis. Can Med Assoc J 155:935–939

    CAS  Google Scholar 

  45. Kuo I, Ong C, Simmons L, Bliuc D, Eisman J, Center J (2007) Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteoporos Int 18:1633–1639

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by a grant from the AAFP Foundation Joint Grant Awards Program (grant number: G0811).

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Family Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555–1123, USA

    A. J. Shepherd, A. R. Cass, L. A. Ray & G. S. Wilkinson

  2. Department of Preventive Medicine & Community Health, The University of Texas Medical Branch, Galveston, TX, USA

    L. A. Ray & G. S. Wilkinson

  3. Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA

    A. Tan

Authors
  1. A. J. Shepherd
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  2. A. R. Cass
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  3. L. A. Ray
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  4. A. Tan
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  5. G. S. Wilkinson
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Corresponding author

Correspondence to A. J. Shepherd.

Additional information

The authors are saddened to report that co-author Ms. Laura Ray passed away during the final revision of the manuscript.

Appendix 1

Appendix 1

Table 4 Study-defined fractures (ICD-9) diagnostic codes
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Shepherd, A.J., Cass, A.R., Ray, L.A. et al. Treatment for older men with fractures. Osteoporos Int 23, 1041–1051 (2012). https://doi.org/10.1007/s00198-011-1681-3

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