The Journal of Bone and Joint Surgery (American). 2008;90:2142-2148.
doi:10.2106/JBJS.G.00864
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Low Incidence of Anti-Osteoporosis Treatment After Hip Fracture

Véronique Rabenda, MSc1, Johan Vanoverloop, MSc2, Valérie Fabri, MD2, Raf Mertens, MD3, François Sumkay, PhD3, Carine Vannecke, MD, PhD4, André Deswaef, PhD4, Gert A. Verpooten, MD, PhD5 and Jean-Yves Reginster, MD, PhD1

1 Department of Public Health, Epidemiology and Health Economics, 3, Avenue de l'Hôpital Bat B23, 4000 Liège, Belgium. E-mail address for V. Rabenda: Veronique.rabenda{at}ulg.ac.be. E-mail address for J.-Y. Reginster: Jyreginster{at}ulg.ac.be
2 Union Nationale des Mutualités Socialistes, Rue Saint-Jean 32-38, 1000 Brussels, Belgium. E-mail address for J. Vanoverloop: Johan.vanoverloop{at}socmut.be. E-mail address for V. Fabri: Valerie.fabri{at}socmut.be
3 Alliance Nationale des Mutualités Chrétiennes, Chaussée de Haecht 579, 1031 Brussels, Belgium. E-mail address for R. Mertens: Raf.mertens{at}cm.be. E-mail address for F. Sumkay: Francois.sumkay{at}cm.be
4 Institut National d'Assurance Maladie Invalidité, Avenue de Tervueren 211, 1150 Brussels, Belgium. E-mail address for C. Vannecke: Carine.vannecke{at}riziv.fgov.be. E-mail address for A. Deswaef: Andre.deswaef{at}riziv.fgov.be
5 Department of Nephrology-Hypertension, University Hospital, Antwerp, Wilrijkstraat 10, 2650 Edegem-Antwerp, Belgium. E-mail address: Gert.verpooten{at}uza.be
Investigation performed at the University of Liège, Liège, Belgium

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Following hip fracture, pharmacologic treatment can reduce the rate of subsequent fragility fractures. The objective of the present study was to assess the proportion of patients who are managed with bisphosphonates or selective estrogen-receptor modulators after hip fracture and to evaluate, among those managed with alendronate, the twelve-month compliance and persistence with treatment.

Methods: Data were gathered from health insurance companies and were collected by AIM (Agence Intermutualiste) for the Belgian National Social Security Institute (INAMI). We selected all postmenopausal women who had been hospitalized for a hip fracture between April 2001 and June 2004 and had not been previously managed with bisphosphonates. Patients who had received alendronate treatment after the hip fracture were categorized according to their formulation use during the follow-up study (daily, weekly, daily followed by weekly, or weekly followed by weekly). Compliance at twelve months was quantified with use of the medication possession ratio (i.e., the number of days of alendronate supplied during the first year of treatment, divided by 365). Persistence with prescribed treatment was calculated as the number of days from the initial prescription to a lapse of more than five weeks after completion of the previous prescription refill. The cumulative treatment persistence rate was determined with use of Kaplan-Meier survival curves.

Results: A total of 23,146 patients who had sustained a hip fracture were identified. Of these patients, 6% received treatment during the study period: 4.6% received alendronate, 0.7% received risedronate, and 0.7% received raloxifene. Bisphosphonate treatment was dispensed to 2.6% and 3.6% of the patients within six months and one year after the occurrence of the hip fracture, respectively. Among women who received alendronate daily (n = 124) or weekly (n = 182) and were followed for at least one year after the hip fracture, the twelve-month mean medication possession ratio was 67% (65.9% in the daily group and 67.7% in the weekly group). The analysis of persistence with treatment included a total of 726 patients (142 in the daily group, 261 in the weekly group, and 323 in the switch group). At twelve months, the rate of persistence was 41% and the median duration of persistence was 40.3 weeks.

Conclusions: The vast majority of patients who experience a hip fracture do not take anti-osteoporotic therapy after the fracture. Furthermore, among patients who begin alendronate treatment after the fracture, the adherence to treatment decreases over time and remains suboptimal.


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