Treatment trends after hip fracture of Veterans with osteoporosis

Abstract: Introduction: Osteoporosis is the most common metabolic bone disease in the United States. It is often underdiagnosed and undertreated resulting in additional fragility fractures. Hip fractures specifically can lead to 8-36 % excess mortality at 1 year. It has been found that 80-95 % of patients in certain practice settings are discharged with insufficient antifracture treatment. We were interested in determining the frequency of transition from oral bisphosphonate to parenteral osteoporosis therapy following hospitalization for a hip fracture in veterans aged 65 and older. Methods: Utilizing the national Department of Veterans Affairs database, VA Informatics and Computing Infrastructure or VINCI, a cohort of patients aged 65 and older with a prior diagnosis of osteoporosis taking bisphosphonates who subsequently had a hip fracture was collected and analyzed. This created a cohort of 46,004 patients. This cohort was divided by gender and included 42,876 males and 3,128 females. The deidentified cohort records were reviewed to determine who received parenteral medications after the hip fracture. Results: Based on the analysis, there were 1,459 patients on parenteral medications in the cohort of 46,004 after hip fracture. This resulted in a percentage of 3.17 % overall. The percentage of women placed on a parenteral medication was 1.66 % and for men was 3.28 %. The most used medication was zoledronic acid (Zoledronic Acid) with 1,190 uses of the 1,459 (81.6 %). Conclusion: Hip fractures have a large impact on morbidity and mortality in the older population. Our study shows opportunity for increased utilization of parenteral therapies in patients who fractured on a background of oral bisphosphonate therapy. Delays may be the result of several issues including cost, recognition of fracture risk change, lack of communication, and comfort with therapies. The low percentage of parenteral medication use indicates some opportunity for more potent treatment. Future research directions could analyze civilian databases to get a more generalizable data set.