No Significant Improvement in Osteoporosis Management of Post-fragility Fracture Patients From 2010 to 2019: A National Database Study.

Abstract

Background: The American Orthopaedic Association initiated the "Own the Bone" program in 2009 to promote a more active involvement of orthopaedic surgeons in managing osteoporosis after fragility fractures. This study investigates the effectiveness of the program by examining the changes in yearly DEXA scan rates and diphosphonate prescriptions since the program's inception.

Methods: Patients aged 50 to 85 years who sustained a femoral neck fracture requiring surgery from 2010 to 2019 were tracked using the PearlDiver database. The study examined annual DEXA scans within 1 year of fracture and diphosphonate treatment within 6 weeks and 1 year. Age, sex, obesity, tobacco, and alcohol use were also analyzed.

Results: In total, 201,499 patients met inclusion criteria (67.0% female). Younger, predominantly female patients more often underwent DEXA scans within 1 year of fracture. Tobacco users, alcohol abusers, and obese patients were also more likely to receive scans. Annual DEXA scan rates from 2010 to 2019 ranged narrowly from 4.66% in 2012 to 5.82% in 2010, ending at 4.87% in 2019. Diphosphonate prescriptions within 1-year postfracture dropped from 5.12% in 2010 to 2.98% in 2019, with early (≤6 weeks) treatment falling from 1.07% to 0.66%, showing no sustained increase over time. Those prescribed bisphosphonates were younger, more likely female, obese, and tobacco users.

Conclusion: The Own the Bone program has not successfully modified orthopaedic surgeons' approaches to managing osteoporosis. This stagnation in practice change could be due to a lack of sufficient incentives or a limited knowledge base that prevents surgeons from providing thorough osteoporosis counseling postfracture.