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Access to Anti-osteoporosis Medication after Hip Fracture in Korean Elderly Patients

  • Yun Mi Yu
    Affiliations
    College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
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  • Ju-Yeun Lee
    Affiliations
    College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55, Hanyangdaehak-ro, Sangrok-gu, Ansan, 15588, Republic of Korea
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  • Euni Lee
    Correspondence
    Corresponding author at: College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak−ro, Gwanak−gu, Seoul, 08826, Republic of Korea.
    Affiliations
    College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
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      Highlights

      • Access to anti-osteoporosis medication after hip fracture was found to be suboptimal in Korea.
      • One in three elderly patients with hip fracture received osteoporosis drug therapy.
      • Very old age, male sex, and comorbidity were risk factors for under-treatment.
      • Thiazolidinedione use was a predictive factor for hip fracture treatment in women.

      Abstract

      Purpose

      This study aims to evaluate access to anti-osteoporosis medication (AOM) and the factors affecting their prescription for Korean elderly patients with a hip fracture.

      Methods

      A cross-sectional study was conducted on hip fracture patients aged 65 years or more using national-level data from 2013 to 2014. The prescription rates of AOM within 3 months after hip fracture were determined and the factors affecting AOM prescriptions were identified through multivariate logistic regression.

      Results

      A total of 6307 elderly patients were selected from a national medical insurance database, giving an estimated 15,768 patients nationally in a nine-month period. One-third of the patients (33.5%) received an AOM prescription and only 9.4% of the patients were prescribed an AOM with calcium and vitamin D supplements. Being 80 years and older (adjusted OR, 0.78; 95% CI, 0.70–0.88) and having three or more comorbid diseases (adjusted OR, 0.66; 95% CI, 0.55–0.78) were associated with a lower likelihood of an AOM prescription. Female sex (adjusted OR, 2.54; 95% CI, 2.17–2.98), an osteoporosis diagnosis (adjusted OR, 2.50; 95% CI, 2.15–2.91), concurrent thiazolidinedione therapy (adjusted OR, 2.11; 95% CI, 1.29–3.45) and a dual-energy X-ray absorptiometry (DXA) examination after hip fracture (adjusted OR 4.11; 95% CI, 3.67–4.62) were all significant predictive factors for AOM prescription. Bisphosphonates were the most frequently prescribed AOMs (92.2%).

      Conclusions

      The AOM prescription rate for elderly patients with hip fractures was suboptimal in Korea. Factors affecting an AOM prescription were age, sex, clinical comorbidity, osteoporosis status, concurrent thiazolidinedione therapy, and receiving a DXA examination after hip fracture.

      Abbreviations:

      AOM (anti osteoporotic medications), IOF (International Osteoporosis Foundation), NOF (National Osteoporosis Foundation), HIRA-APS (Health Insurance Review and Assessment Service-Adult Patient Sample), HIRA (Health Insurance Review and Assessment Service), ICD (International Classification of Diseases), DXA (dual-energy X-ray absorptiometry), CCI (Charlson Comorbidity Index), SERM (selective estrogen receptor modulator), OR (odds ratio), CI (confidence interval), SD (standard deviation)

      Keywords

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