Medical Student Stanford University School of Medicine Stanford, California, United States
Introduction: Osteoporosis affects over 200 million individuals worldwide and predisposes to vertebral compression fractures (VCFs). Given under-treatment of fragility fractures, including VCFs, we investigate current anti-osteoporotic medication prescribing trends.
Methods: Patients 18 and older with a diagnosis of primary closed thoracolumbar VCF between 2004 and 2019 were identified from the Clinformatics® Data Mart (CDM) Database. Multivariate analysis was performed for demographic and clinical treatment and outcome variables.
Results: Of 175,857 patients with primary VCFs, 17,192 (10.1%) were started on anti-osteoporotic medication within a year. 153,143 (89.9%) patients were not started on medication. The medication cohort was older (74.6±10.7 vs. 67.2±18.9 years, p< 0.001), had higher Elixhauser Comorbidity Scores (4.23±6.2 vs. 3.99±6.4, p< 0.001), was more likely to be female (80.5% vs. 59.8%, p< 0.001), and more likely to have a formal osteoporosis diagnosis (47.1% vs. 27.6%) than the group that did not receive medication. Alendronate (63.1%) and calcitonin (28.0%) were the most commonly started medications. The proportion of individuals receiving anti-osteoporotic medication within the year following VCF peaked in 2008 (11.7%), then declined until 2012 with a modest increase afterwards. After adjusting for baseline demographics and variables in multivariate regression, patients who received a percutaneous spine procedure (kyphoplasty or vertebroplasty) were 8.61 times (OR=8.61, 95%CI=8.378-9.267, p< 0.001) more likely to experience a secondary fragility fracture within a year after the VCF.
Conclusion : Osteoporosis remains undertreated after low-energy VCFs. Despite approval of new anti-osteoporotic medication classes in recent years, bisphosphonates remain the most prescribed class. Increasing recognition and treatment of osteoporosis is paramount to decreasing the risk of subsequent fractures.
