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

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


      • 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.



      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.


      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.


      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%).


      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.


      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)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bliuc D.
        • Nguyen N.D.
        • Milch V.E.
        • Nguyen T.V.
        • et al.
        Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women.
        JAMA J.AM. Med. Assoc. 2009; 301: 513-521
        • Burge R.
        • Dawson-Hughes B.
        • Solomon D.H.
        • Wong J.B.
        • et al.
        Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025.
        J. Bone. Miner. Res. 2007; 22: 465-475
        • Cauley J.A.
        • Chalhoub D.
        • Kassem A.M.
        • Fuleihan Gel H.
        Geographic and ethnic disparities in osteoporotic fractures.
        Nat. Rev. Endocrinol. 2014; 10: 338-351
        • Ha Y.C.
        • Kim T.Y.
        • Lee A.
        • Lee Y.K.
        • et al.
        Current trends and future projections of hip fracture in South Korea using nationwide claims data.
        Osteoporos. Int. 2016; 27: 2603-2609
        • Cosman F.
        • de Beur S.J.
        • LeBoff M.S.
        • Lewiecki E.M.
        • et al.
        Clinician's guide to prevention and treatment of osteoporosis.
        Osteoporos. Int. 2014; 25: 2359-2381
        • Kanis J.A.
        • McCloskey E.V.
        • Johansson H.
        • Cooper C.
        • et al.
        European guidance for the diagnosis and management of osteoporosis in postmenopausal women.
        Osteoporos. Int. 2013; 24: 23-57
        • Makridis K.G.
        • Karachalios T.
        • Kontogeorgakos V.A.
        • Badras L.S.
        • Malizos K.N.
        The effect of osteoporotic treatment on the functional outcome, re-fracture rate, quality of life and mortality in patients with hip fractures: a prospective functional and clinical outcome study on 520 patients.
        Injury. 2015; 46: 378-383
        • Lyles K.W.
        • Colon-Emeric C.S.
        • Magaziner J.S.
        • Adachi J.D.
        • et al.
        Zoledronic acid and clinical fractures and mortality after hip fracture.
        N. Engl. J. Med. 2007; 357: 1799-1809
        • Kim S.C.
        • Kim M.S.
        • Sanfelix-Gimeno G.
        • Song H.J.
        • et al.
        Use of osteoporosis medications after hospitalization for hip fracture: a cross-national study.
        Am. J. Med. 2015; 128: 519-526
        • Brozek W.
        • Reichardt B.
        • Zwerina J.
        • Dimai H.P.
        • et al.
        Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: a nationwide study.
        Osteoporos. Int. 2016; 27: 387-396
        • Solomon D.H.
        • Johnston S.S.
        • Boytsov N.N.
        • McMorrow D.
        • et al.
        Osteoporosis medication use after hip fracture in U. S, patients between 2002 and 2011.
        J. Bone. Miner Res. 2014; 29: 1929-1937
        • Kang H.Y.
        • Yang K.H.
        • Kim Y.N.
        • Moon S.H.
        • et al.
        Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data.
        BMC public health. 2010; 10: 230
        • Bor A.
        • Matuz M.
        • Gyimesi N.
        • Biczok Z.
        • et al.
        Gender inequalities in the treatment of osteoporosis.
        Maturitas. 2015; 80: 162-169
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J. Chronic. Dis. 1987; 40: 373-383
        • Zhou J.
        • Ma X.
        • Wang T.
        • Zhai S.
        Comparative efficacy of bisphosphonates in short-term fracture prevention for primary osteoporosis: a systematic review with network meta-analyses.
        Osteoporos. Int. 2016;
        • Guralp O.
        • Erel C.T.
        Effects of vitamin K in postmenopausal women: mini review.
        Maturitas. 2014; 77: 294-299
        • Teschemaker A.
        • Lee E.
        • Xue Z.
        • Wutoh A.K.
        Osteoporosis pharmacotherapy and counseling services in US ambulatory care clinics: opportunities for multidisciplinary interventions.
        Am. J. Geriatr. Pharmacother. 2008; 6: 240-248
        • Ministry Health and Welfare
        Change notification to reimbursement standards.
        2012 (, (Accessed 16 August 20))
        • Corsonello A.
        • Pedone C.
        • Incalzi R.A.
        Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions.
        Curr. Med. Chem. 2010; 17: 571-584
        • Zhang M.
        • Holman C.D.
        • Price S.D.
        • Sanfilippo F.M.
        • et al.
        Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study.
        BMJ. 2009; 338: a2752
        • Tsoi C.S.
        • Chow J.Y.
        • Choi K.S.
        • Li H.W.
        • et al.
        Medical characteristics of the oldest old: retrospective chart review of patients aged 85+ in an academic primary care centre.
        BMC Res notes. 2014; 7: 340
        • Morgan E.N.
        • Crawford D.A.
        • Scully W.F.
        • Noce N.J.
        Medical management of fragility fractures of the distal radius.
        Orthopedics. 2014; 37: e1068-1073
        • Uriz-Otano F.
        • Pla-Vidal J.
        • Tiberio-Lopez G.
        • Malafarina V.
        Factors associated to institutionalization and mortality over three years, in elderly people with a hip fracture-An observational study.
        Maturitas. 2016; 89: 9-15
        • Haentjens P.
        • Magaziner J.
        • Colon-Emeric C.S.
        • Vanderschueren D.
        • et al.
        Meta-analysis: excess mortality after hip fracture among older women and men.
        Ann. Intern. Med. 2010; 152: 380-390
        • Yaturu S.
        • Bryant B.
        • Jain S.K.
        Thiazolidinedione treatment decreases bone mineral density in type 2 diabetic men.
        Diabetes Care. 2007; 30: 1574-1576
        • Palermo A.
        • D'Onofrio L.
        • Eastell R.
        • Schwartz A.V.
        • et al.
        Oral anti-diabetic drugs and fracture risk, cut to the bone: safe or dangerous? A narrative review.
        Osteoporos. Int. 2015; 26: 2073-2089
        • Schwartz A.V.
        • Sellmeyer D.E.
        • Vittinghoff E.
        • Palermo L.
        • et al.
        Thiazolidinedione use and bone loss in older diabetic adults.
        J. Clin. Endocrinol. Metab. 2006; 91: 3349-3354
        • Loke Y.K.
        • Singh S.
        • Furberg C.D.
        Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis.
        CMAJ. 2009; 180: 32-39
        • Black D.M.
        • Delmas P.D.
        • Eastell R.
        • Reid I.R.
        • Boonen S.
        • Cauley J.A.
        • Cosman F.
        • Lakatos P.
        • Leung P.C.
        • Man Z.
        • Mautalen C.
        • Mesenbrink P.
        • Hu H.
        • Caminis J.
        • Tong K.
        • Rosario-Jansen T.
        • Krasnow J.
        • Hue T.F.
        • Sellmeyer D.
        • Eriksen E.F.
        • Cummings S.R.
        Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis.
        N. Engl. J. Med. 2007; 356: 1809-1822
        • Overman R.A.
        • Borse M.
        • Gourlay M.L.
        Salmon calcitonin use and associated cancer risk.
        Ann. Pharmacother. 2013; 47: 1675-1684