Testing and treatment for osteoporosis following hip fracture in an integrated U.S. healthcare delivery system

Older veterans with acute hip fracture do not receive adequate evaluation and treatment for osteoporosis, irrespective of their age and underlying health status. Introduction: Hip fractures are a serious complication of osteoporosis, leading to high mortality and morbidity. Prior studies have found significant undertreatment of osteoporosis in women with hip fracture. We examined the rate of bone density (BMD) testing and osteoporosis treatment among a predominantly male population hospitalized with hip fractures. Methods: We conducted a retrospective cohort study of patients age 65 years and older hospitalized in U.S. Department of Veterans Affairs (VA) hospitals with hip fracture (N=3,347) between 1 October, 2004 and 30 September, 2006. The primary outcome was receipt of BMD testing or initiation of pharmacotherapy within 12 months of fracture. Results: The mean age of the study population was 79.0 years (SD=6.7), 96.5% were male, and 83.3% were white. Only 1.2% of hip fracture patients underwent BMD testing and 14.5% received osteoporosis therapy within 12 months of fracture. Among fracture patients with minimal comorbid illness (N=756) only 1.6% underwent BMD testing and 13.0% received pharmacotherapy. In logistic regression models, treatment rates were higher for women compared to men (odds ratio, 3.30; 95% CI, 2.16-5.04) and lower for blacks compared to whites (odds ratio, 0.67; 95% CI, 0.45-0.99). Conclusions: Evaluation and treatment of osteoporosis among patients with fractures is suboptimal even in an integrated healthcare delivery system with generous pharmaceutical coverage. This study suggests that the undertreatment of osteoporosis demonstrated in the private sector is also present within the VA.