Geographic variation in secondary fracture prevention after a hip fracture during 1999-2013: a UK study

Journal article

Purpose

To describe the geographic variation in anti-osteoporosis drug therapy prescriptions before and after a hip fracture during 1999-2013 in the UK.

Methods

We used primary care data (Clinical Practice Research Datalink) to identify patients with a hip fracture and primary care prescriptions of any anti-osteoporosis drugs prior to the index hip fracture and up to five years after. Geographic variations in prescribing before and after availability of generic oral bisphosphonates were analysed. Multivariable logistic regression models were adjusted for gender, age and body mass index (BMI).

Results

13,069 patients (76% female) diagnosed with a hip fracture during 1999-2013 were identified. 11% had any anti-osteoporosis drug prescription in the six months prior to the index hip fracture. In the 0-4 months following a hip fracture 5% of patients were prescribed anti-osteoporosis drugs in 1999, increasing to 51% in 2011 to then decrease to 39% in 2013.

The independent predictors (OR (95%CI)) of treatment initiation included gender (male:0.42 (0.36-0.49)), BMI (0.98 per kg/m2 increase (0.97-1.00)) and geographic region (1.29 (0.89-1.87) North East vs. 0.56(0.43-0.73) South Central region). Geographic differences in prescribing persisted over the 5-year follow-up. If all patients were treated at the rate of the highest performing region, then nationally an additional 3,214 hip fracture patients would be initiated on therapy every year.

Conclusions

Significant geographic differences exist in prescribing of anti-osteoporosis drugs after hip fracture despite adjustment for potential confounders. Further work examining differences in health care provision may inform strategies to improve secondary fracture prevention after hip fracture.

Authors: Shah, A; Prieto Alhambra, D; Hawley, S; Delmestri, A; Lippett, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Osteoporosis International
• Volume: 28
• Issue: 1
• Pages: 169–178
• Publication date: 2016-11-01
• Acceptance date: 2016-10-13
• DOI: 10.1007/s00198-016-3811-4
• EISSN: 1433-2965
• ISSN: 0937-941X