Quality of Osteoporosis Care of Older Medicare Recipients with Fragility Fractures: 2006 to 2010

Authors

  • Stephen K. Liu MD, MPH,

    Corresponding author
    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    3. Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    4. Leadership Preventive Medicine Residency Program, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    5. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, New Hampshire
    • Address correspondence to Stephen K. Liu, Dartmouth-Hitchcock Medical Center, Section of Hospital Medicine, One Medical Center Drive, Lebanon, NH 03756. E-mail: stephen.k.liu@hitchcock.org

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  • Jeffrey C. Munson MD, MSCE,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    3. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, New Hampshire
    4. Veterans Affairs Medical Center, White River Junction, Vermont
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  • John-Erik Bell MD, MS,

    1. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, New Hampshire
    2. Department of Orthopedics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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  • Rebecca L. Zaha MPH,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
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  • John N. Mecchella MD, MPH,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    3. Leadership Preventive Medicine Residency Program, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    4. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, New Hampshire
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  • Anna N. A. Tosteson ScD,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    3. Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    4. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, New Hampshire
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  • Nancy E. Morden MD, MPH

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    3. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, New Hampshire
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Abstract

Objectives

To assess uptake of postfracture care guidelines in community-dwelling Medicare recipients with fractures.

Design

Retrospective observational cohort study.

Setting

Claims-based study using U.S. Medicare administrative inpatient, outpatient (2003–2010), and prescription (2006–2010) data.

Participants

Individuals aged 68 and older who survived at least 12 months after a fracture of the hip, radius, or humerus.

Measurements

Poisson regression modeled factors, including participant characteristics, comorbidities and hospital referral region (HRR), associated with bone density testing or osteoporosis pharmacotherapy in the 6 months after fracture. Models were repeated for participants with no osteoporosis care observed before fracture (attention naïve).

Results

In 61,832 individuals with fractures, mean age was 80.6, 87.0% were female, 88.5% were white, 2.6% were black, and 62.1% were attention naïve at the time of fracture; 21.8% received testing, pharmacotherapy, or both in the 6 months after fracture. In adjusted models, factors associated with significantly lower likelihood of receiving this care were black race, male sex, and an upper extremity fracture (vs hip). In models restricted to attention-naïve participants, the same factors were associated with lower relative risk of receiving care. Adjusted HRR-level care rates ranged from 14.7% to 22.9% (10th to 90th percentile). The proportion receiving care increased from 2006 to 2009.

Conclusion

Postfracture osteoporosis care was uncommon, particularly in black and male participants. Care increased over time, but for most, a fracture was insufficient to trigger effective secondary prevention, especially for participants who were not receiving prefracture osteoporosis attention. Clinicians and policy-makers must consider effective remedies to this persistent care gap.

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