OBJECTIVES

Osteoporotic fractures are an important public health burden, and with an increasing aging population, the number of Americans at risk of fractures is projected to increase 33% by 2030. The objective of this study was to evaluate osteoporosis management in Medicare enrollees.

METHODS

This study included Medicare fee-for-service (FFS) members with a closed fragility (or osteoporosis-related) fracture between 01/01/2010-12/31/2014. Cohort characteristics were computed yearly for 2010-2014 in order to examine secular trends in osteoporosis management. Inclusion criteria for cohort eligibility was age ≥65 at index date, continuous enrollment in Medicare FFS with medical and pharmacy benefits for ≥1 year before index date. Patients with Paget’s disease or malignancy (except non-melanoma skin cancer) at baseline were excluded.

RESULTS

Of 18,936,386 beneficiaries, 885,676 had fracture(s) and met eligibility criteria. Average age was 80.5(±8.4) years, 90.9% were white, and 93.8% female. Over half of patients in each yearly cohort had a comorbidity or a medication that increased fall risk, with approximately 50% of patients using opioids. Despite increased fall risk, osteoporosis diagnosis, screening, and treatment rates at baseline were low and decreased from 2010-2014:DXA: 25%, 24%, 23%, 22%,16%; diagnosis: 7%, 6%, 6%, 5%, 4%; treatment: 29%, 24%, 20%, 16%, 11%. A trend toward lower OP diagnosis and treatment utilization over time was observed.

CONCLUSIONS

These findings suggest continued and perhaps worsening osteoporotic fracture management over time. Opportunities exist to better identify and treat patients who have an increased risk of fracture.