Elderly Health

Adequate drug therapy for individuals aged 65-85 after a hip fracture

Individuals who purchased during the measurement year adequate drug therapy (numerator), among Individuals after a hip fracture aged 66-84 years (denominator)

Rational:

Osteoporotic fractures are a common phenomenon among elderly adults, and their incidence increases with the aging of the population. An estimated nine million osteoporotic fractures are diagnosed each year around the world [1], [2]. In approximately half of the cases, permanent functional impairment remains after the fracture, and one in four cases leads to a transition to a nursing home or death within a year. The first osteoporotic fracture is a significant risk factor for a subsequent fracture [3], which is why it is of paramount importance for secondary prevention. Currently, there are several drug treatments that have proven to be effective in preventing a subsequant fracture - bisphosphonates, teriparatide, denosumab [4], [5]. However, according to US data, less than a quarter of the elderly who had a hip fracture are receiving adequate drug therapy [6]. This data emphasizes the importance of a national quality indicator for assessing adequate drug therapy after a hip fracture for the prevention of a second fracture.

Numerator:

Individuals who purchased during the measurement year adequate drug therapy: at least one purchase of denosumab (prolia) or zoledronic acid (aclasta) or 3 or more purchases of other bisphosphonates or teriparatide

Denominator

Individuals aged 66-84 years (during the measurement year) who had a hip fracture a year before the measurement year

Notes:

Notes:

[1] Berry SD, Kiel DP, Colón-Emeric C. Hip fractures in older adults in 2019. JAMA - J Am Med Assoc. 2019 Jun 11;321(22):2231–2.
16. International Osteoporosis Foundation. Facts and Statistics. Available from: https://www.iofbonehealth.org/facts-statistics#category-14
[2] National Osteoporosis Society (UK). Effective Secondary Prevention of Fragility Fractures 2015. [cited 2019 Oct 2]; Available from: https://theros.org.uk/media/2082/clinical-standards-for-fracture-liaison-services.pdf
[3] Saito T, Sterbenz JM, Malay S, Zhong L, MacEachern MP, Chung KC. Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int [Internet]. 2017 Dec [cited 2019 Oct 23];28(12):3289–300. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28770272
[4] Conley RB, Adib G, Adler RA, Akesson KE, Alexander IM, Amenta KC, et al. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Bone Miner Res. 2019 Sep 20;
[5] Bauer DC. Osteoporosis Treatment After Hip Fracture- Bad News and Getting Worse. JAMA Netw Open. 2018 Jul 20;1(3):e180844.

Results:
Adequate drug treatment rate after a hip fracture by year
Adequate drug treatment rate after a hip fracture by socio-economic position (1-lowest, 4-highest) and sex


National Program for Quality Indicators in Community Healthcare
התכנית הלאומית למדדי איכות לרפואת הקהילה בישראל