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Patient and Physician Predictors of Post-Fracture Osteoporosis Management
Adam E. Block, PhD2, Daniel H. Solomon, MD, MPH1,3, Suzanne M. Cadarette, PhD1, Helen Mogun, MS1, and Niteesh K. Choudhry, MD, PhD1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA;
2Joint Committee on Taxation, US Congress, Washington, DC, USA; 3Division of Rheumatology, Brigham and Womens Hospital, Boston, MA, USA.
BACKGROUND: Undertreatment of osteoporosis after hip or wrist fracture has been well documented, but the reasons for current patterns of care are poorly understood.
OBJECTIVE: We tested the role of physician and patient characteristics in predicting undertreatment when osteoporosis management was clearly indicated after a hip or wrist fracture in women over age 65.
METHODS: We assembled a cohort of 9,698 female Medicare beneficiaries aged 65 years who experienced hip or wrist fracture between 2000 and 2004 and their prescribing physicians.
MEASUREMENTS: The dominant prescriber was identified as the physician prescribing at least 50% of patient prescriptions in the year after the fracture. Multivariate logistic regression estimated the role of physician and patient characteristics on osteoporosis management after hip or wrist fracture.
RESULTS: Patients older than 90 and black patients were less likely to be treated for osteoporosis relative to patients aged 6569 and white patients. Female providers were more likely to manage osteoporosis. Models including patient characteristics discriminated well between managed and unmanaged patients (C statistic0.81), while adding physician predictors to the model provided no additional discriminatory ability (C statistic0.81).
CONCLUSIONS: Our findings highlight that osteoporosis management rates are similar across providers, but vary considerably by patient types.
KEY WORDS: osteoporosis; fracture; physician characteristics; bisphosphonates; patient characteristics.
J Gen Intern Med 23(9):144751DOI: 10.1007/s11606-008-0697-7 Society of General Internal Medicine 2008
INTRODUCTION
Fractures related to osteoporosis are common, causing morbidity or mortality in 2 million Americans and costing $19 billion predicted for 2005.1 Bone mineral density testing and/ or pharmacologic osteoporosis treatment are indicated for all patients with an osteoporosis-associated fracture.1 In spite of the availability of numerous post-fracture treatment options, osteoporosis management is suboptimal, with fewer than half of post-fracture patients receiving pharmacotherapy.2 One study found that 21% of patients with hip fracture and 23% of patients with wrist fracture were prescribed pharmacologic treatment for osteoporosis and that the probability of...