To investigate the prescribing patterns of antifracture medications following non-traumatic fractures and identify disparities in treatment.
Approach:
Study Design: A retrospective cohort investigation using electronic health records and pharmacy prescription-fill data within a large academic health system.
Cohort Description: Included individuals older than 50 years hospitalized for hip, femur, pelvis, or vertebral fractures from January 1, 2017, to August 31, 2023.
Outcome Measures: Primary outcome was the receipt of antifracture medications during hospitalization or as an outpatient after discharge.
Key Findings:
91% of nearly 10,000 patients admitted with a new non-traumatic fracture had not previously received treatment.
Only 6% of treatment-naïve patients received antifracture medication during hospitalization or as an outpatient.
77% of those treated received therapy during the hospital encounter, while 23% received it in the outpatient setting.
Factors associated with reduced likelihood of treatment included male sex, Black race, longer hospital stay, and femur fracture.
71% of patients who initiated medication during hospitalization continued therapy as outpatients.
Interpretation:
Initiating antifracture medication during hospitalization increases the likelihood of continued treatment post-discharge, highlighting the need for interventions to promote this practice.
Limitations:
The study was conducted in a single academic health center, which may not represent national trends.
Outpatient follow-up was limited to 180 days post-discharge, potentially underestimating treatment rates.
Conclusion:
Addressing the osteoporosis care gap requires integrating hospital settings into osteoporosis management and implementing system-level policy modifications and financial incentives.
Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.
Federal prosecutors allege that a Florida physician and research staff fabricated clinical trial records that were submitted into database systems used to evaluate investigational drugs.
