Skip to main content
Journal cover image

Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death.

Publication ,  Journal Article
Curtis, JR; Arora, T; Matthews, RS; Taylor, A; Becker, DJ; Colon-Emeric, C; Kilgore, ML; Morrisey, MA; Saag, KG; Safford, MM; Warriner, A; Delzell, E
Published in: J Am Med Dir Assoc
October 2010

INTRODUCTION: Undertreatment of osteoporosis is common, even for high-risk patients. Among the reasons for undertreatment may be a clinician's perception of a lack of treatment benefit, particularly in light of patients' expected future mortality. Among US Medicare beneficiaries, we evaluated the risk for second fracture versus death in the 5 years following a hip, clinical vertebral, and wrist/forearm fracture. METHODS: Using data from 1999 to 2006 for a random 5% sample of US Medicare beneficiaries, we identified individuals who experienced an incident hip, clinical vertebral, or wrist/forearm fracture in 2000 or 2001. We evaluated the risk for a second incident fracture versus death in the following 5 years. Results were stratified by age, gender, race/ethnicity, and medical comorbidities. In light of the competing mortality risk, and assuming 30% efficacy of an osteoporosis medication to prevent a second fracture, we calculated the number of individuals needed to treat (NNT) for 5 years after first fracture to prevent 1 additional subsequent fracture. RESULTS: We identified 18,853, 12,751, and 7635 persons with an incident hip, clinical vertebral, and wrist/forearm fracture, respectively. Although the 5-year risk of death usually exceeded the risk for second fracture across age, gender, racial groups, and primary fracture type (median ratio of death to second fracture=1.4, interquartile range 0.9, 2.0), the 5-year risk for second fracture was high, varying from a low of 13% to a high of 43%. Across demographic groups, the NNT to prevent a second fracture was low, ranging from 8 to 46. CONCLUSION: Among older persons with hip, clinical vertebral, or wrist/forearm fracture, although the risk for death was usually greater than the risk for a second fracture, both were high. The relatively low NNT to prevent 1 additional subsequent fracture fell within a range generally considered acceptable for secondary prevention strategies.

Duke Scholars

Published In

J Am Med Dir Assoc

DOI

EISSN

1538-9375

Publication Date

October 2010

Volume

11

Issue

8

Start / End Page

584 / 591

Location

United States

Related Subject Headings

  • Withholding Treatment
  • United States
  • Statistics as Topic
  • Secondary Prevention
  • Risk Assessment
  • Osteoporosis
  • Male
  • Insurance Claim Review
  • Humans
  • Geriatrics
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Curtis, J. R., Arora, T., Matthews, R. S., Taylor, A., Becker, D. J., Colon-Emeric, C., … Delzell, E. (2010). Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc, 11(8), 584–591. https://doi.org/10.1016/j.jamda.2009.12.004
Curtis, Jeffrey R., Tarun Arora, Robert S. Matthews, Allison Taylor, David J. Becker, Cathleen Colon-Emeric, Meredith L. Kilgore, et al. “Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death.J Am Med Dir Assoc 11, no. 8 (October 2010): 584–91. https://doi.org/10.1016/j.jamda.2009.12.004.
Curtis JR, Arora T, Matthews RS, Taylor A, Becker DJ, Colon-Emeric C, et al. Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc. 2010 Oct;11(8):584–91.
Curtis, Jeffrey R., et al. “Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death.J Am Med Dir Assoc, vol. 11, no. 8, Oct. 2010, pp. 584–91. Pubmed, doi:10.1016/j.jamda.2009.12.004.
Curtis JR, Arora T, Matthews RS, Taylor A, Becker DJ, Colon-Emeric C, Kilgore ML, Morrisey MA, Saag KG, Safford MM, Warriner A, Delzell E. Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc. 2010 Oct;11(8):584–591.
Journal cover image

Published In

J Am Med Dir Assoc

DOI

EISSN

1538-9375

Publication Date

October 2010

Volume

11

Issue

8

Start / End Page

584 / 591

Location

United States

Related Subject Headings

  • Withholding Treatment
  • United States
  • Statistics as Topic
  • Secondary Prevention
  • Risk Assessment
  • Osteoporosis
  • Male
  • Insurance Claim Review
  • Humans
  • Geriatrics