Seoyoung C Kim1, Mi-Sook Kim2, Gabriel Sanfélix-Gimeno3, Hong Ji Song4, Jun Liu5, Isabel Hurtado3, Salvador Peiró3, Joongyub Lee6, Nam-Kyong Choi6, Byung-Joo Park7, Jerry Avorn5. 1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. Electronic address: skim62@partners.org. 2. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. 3. Health Services Research Unit, Center for Public Health Research, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Valencia, Spain. 4. Department of Family Medicine, Health Promotion Center, Hallym University Sacred Heart Hospital, Anyang, Korea. 5. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. 6. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea. 7. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea; Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
Abstract
BACKGROUND: Although current osteoporosis management guidelines recommend use of pharmacologic treatment after hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study was to quantify the use of and adherence to osteoporosis medication after hip fracture in 3 countries with different healthcare systems—the United States, Korea, and Spain. METHODS: In 3 cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year after the hip fracture. RESULTS: We identified 86,202 patients with a hip fracture: 4704 (US Medicare), 6700 (US commercial), 57,631 (Korea), and 17,167 (Spain). The mean age was 77-83 years, and 74%-78% were women. In the year before the index hip fracture, 16%-18% were taking an osteoporosis medication. Within 3 months after the index hip fracture, 11% (US Medicare), 13% (US commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled ≥1 prescriptions for an osteoporosis medication, the mean PDC in the year after the fracture was 0.70 (US Medicare), 0.67 (US commercial), 0.43 (Korea), and 0.66 (Spain). CONCLUSIONS: Regardless of differences in healthcare delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal, with the PDC <0.70 in all 3 countries.
BACKGROUND: Although current osteoporosis management guidelines recommend use of pharmacologic treatment after hip fracture, the care of such patients has been suboptimal. The objective of this cross-national study was to quantify the use of and adherence to osteoporosis medication after hip fracture in 3 countries with different healthcare systems—the United States, Korea, and Spain. METHODS: In 3 cohorts of patients aged ≥65 years hospitalized for hip fracture, we calculated the proportion receiving ≥1 osteoporosis drug after discharge. Adherence to osteoporosis treatment was measured as the proportion of days covered (PDC) during the first year after the hip fracture. RESULTS: We identified 86,202 patients with a hip fracture: 4704 (US Medicare), 6700 (US commercial), 57,631 (Korea), and 17,167 (Spain). The mean age was 77-83 years, and 74%-78% were women. In the year before the index hip fracture, 16%-18% were taking an osteoporosis medication. Within 3 months after the index hip fracture, 11% (US Medicare), 13% (US commercial), 39% (Korea), and 25% (Spain) of patients filled ≥1 prescription for osteoporosis medication. For those who filled ≥1 prescriptions for an osteoporosis medication, the mean PDC in the year after the fracture was 0.70 (US Medicare), 0.67 (US commercial), 0.43 (Korea), and 0.66 (Spain). CONCLUSIONS: Regardless of differences in healthcare delivery systems and medication reimbursement plans, the use of osteoporosis medications for the secondary prevention of osteoporotic fracture was low. Adherence to osteoporosis treatment was also suboptimal, with the PDC <0.70 in all 3 countries.
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