Reports of Medicare data suggest that osteoporotic fracture incidence in the United States—which had been declining—is not only no longer declining, but may be on the rise, explains Setareh Aria Williams, PhD. However, “payers and healthcare professionals (HCPs) alike may not be aware that fractures account for more hospitalizations than myocardial infarction, stroke or breast cancer, and postmenopausal women may be unaware fractures could be related to osteoporosis and that they increase the risk of future fractures,” she adds. For a study published in Osteoporosis International, Dr. Williams and colleagues sought to increase awareness regarding the burden of osteoporotic fracture in the United States.
The researchers used administrative medical and pharmacy claims and enrollment information from the Optum Research Database between 2007 and 2017, as well as a diagnostically validated algorithm, to evaluate fracture trends in US commercial and Medicare Advantage health plan members aged 50 or older. The overall age- and sex-adjusted fracture rate per 1,000 person-years (py) decreased from 14.67 in 2007 to 11.79 in 2013, but it then plateaued for 3 years before increasing to 12.50 in mid-2017. Similar trends were observed in both males and females aged 65 and older. Age- and sex-adjusted fracture rates declined by 3.7% per year between 2007 and 2013 for most fracture sites. “It is important to note that the observed plateau or increase in fracture rates has occurred despite the availability of treatments approved for fracture risk reduction,” notes Dr. Williams, adding that these trends, however, have occurred in parallel with observed population-based declines in screening and treatment of osteoporosis.
Dr. Williams indicates the need for future research focused on identification of patients at risk for fracture using simple tools that can be implemented by HCPs using readily available data in the absence of imaging results. In the meantime, the study team notes the importance, in the absence of routing screening for primary prevention, of raising awareness for a thorough assessment of risks and mitigation plans for secondary fracture prevention. “We suggest incorporation of further education of medical students and residents on this topic,” says Dr. Williams, “and encourage physicians to use all available resources to better manage patients at high risk for fractures.”