Quality of Osteoporosis Care of Older Medicare Recipients with Fragility Fractures: 2006 to 2010

ObjectivesTo assess uptake of postfracture care guidelines in community-dwelling Medicare recipients with fractures. DesignRetrospective observational cohort study. SettingClaims-based study using U.S. Medicare administrative inpatient, outpatient (2003-2010), and prescription (2006-2010) data. ParticipantsIndividuals aged 68 and older who survived at least 12months after a fracture of the hip, radius, or humerus. MeasurementsPoisson regression modeled factors, including participant characteristics, comorbidities and hospital referral region (HRR), associated with bone density testing or osteoporosis pharmacotherapy in the 6months after fracture. Models were repeated for participants with no osteoporosis care observed before fracture (attention naive). ResultsIn 61,832 individuals with fractures, mean age was 80.6, 87.0% were female, 88.5% were white, 2.6% were black, and 62.1% were attention naive at the time of fracture; 21.8% received testing, pharmacotherapy, or both in the 6months after fracture. In adjusted models, factors associated with significantly lower likelihood of receiving this care were black race, male sex, and an upper extremity fracture (vs hip). In models restricted to attention-naive participants, the same factors were associated with lower relative risk of receiving care. Adjusted HRR-level care rates ranged from 14.7% to 22.9% (10th to 90th percentile). The proportion receiving care increased from 2006 to 2009. ConclusionPostfracture osteoporosis care was uncommon, particularly in black and male participants. Care increased over time, but for most, a fracture was insufficient to trigger effective secondary prevention, especially for participants who were not receiving prefracture osteoporosis attention. Clinicians and policy-makers must consider effective remedies to this persistent care gap.