Impact of social determinants on osteoporosis treatment and secondary fracture risk after primary fragility fractures

Summary

This study examined the impact of social determinants of health (SDOH) on osteoporosis management and secondary fractures after primary fragility fractures. Despite similar osteoporosis treatment rates between patients with and without adverse SDOH, patients with adverse SDOH experienced significantly higher secondary fracture rates, highlighting the need for targeted interventions to improve post-fracture care in socioeconomically disadvantaged populations.

Purpose

Osteoporosis is a global health concern affecting over 500 million people. Fragility fractures are often the first indication of osteoporosis and are associated with significant morbidity and mortality. While low socioeconomic status is associated with increased risk of fragility fractures, the impact of social determinants of health (SDOH) on osteoporosis treatment and secondary fracture rates following primary fragility fractures remains unclear.

Methods

Patients aged 50 and older who sustained primary fragility fractures and had no prior osteoporosis treatment were identified using a large national database. Patients were stratified by the presence of adverse SDOH. Kaplan–Meier and multivariate Cox proportional hazards regression analyses were performed to evaluate the cumulative incidence of osteoporosis treatment within 1 year (including bisphosphonates, biologics, parathyroid hormone analogs, estrogens, and selective estrogen receptor modulators) and rates of secondary fractures within two years.

Results

A total of 276,845 patients were included in this study. Overall, 4.4% of patients with adverse SDOH and 5.3% of patients without were prescribed osteoporosis treatment within a year of fracture; however, this difference was not significant after controlling for confounders (hazard ratio (HR) 0.98; P = 0.82). Patients with adverse SDOH had significantly higher rates of secondary fractures within 2 years (7.4% versus 6.0%; HR 1.29; P < 0.001).

Conclusion

Adverse SDOH were associated with increased rates of secondary fractures among patients with primary fragility fractures, despite similar osteoporosis management rates between groups. Overall, osteoporosis treatment rates remain low. Targeted strategies to optimize secondary prevention and tailored interventions are needed, particularly for socioeconomically disadvantaged populations.