Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence

Initiation and compliance with anti-osteoporotic therapy was assessed in 152,777 fracture patients in a national population-based cohort study. Prescription rates were low, especially following hip fracture. Persistence has improved with almost 2/3 of patients who began raloxifene or weekly alendronate obtaining treatment durations equalling those of the licensing trials. Reducing the societal fracture burden remains challenging due to failure to treat fragility fractures and non-compliance with treatment. We used national registers to identify patients born 1945 or earlier who sustained a fracture 1997-2004 (N = 152,777). Initiation of anti-osteoporotic therapy was defined as redemption of at least one prescription in the year following fracture. Persistence was defined as duration of time maintaining a medication possession ratio > 75%. Treatment initiation within 1 year was highest after spine fracture: 39.6% of women began therapy in 2004 compared with 19.5% in 1997. In men, 16.5% began therapy in 2004 vs. 8.0% in 1997. Following hip fracture, 9.2% of women and 4.1% of men began therapy in 2004 vs. 3.4% and 0.7% in 1997, respectively. Median persistence (years) was 2.8 for daily alendronate, 3.8 for weekly alendronate, 2.5 for etidronate and 4.7 for raloxifene. The risk of discontinuing or changing therapy increased with age. Prescription rates for anti-osteoporotic medication are very low, especially in hip fracture and in men. Rates were < 1/3 of those reported in the US. Persistence has improved with almost 2/3 of patients who began raloxifene or weekly alendronate now obtaining treatment durations equalling those of the licensing trials.