Factors influencing diagnosis and treatment of osteoporosis after a fragility fracture among postmenopausal women in Asian countries: a retrospective study
1 Department of Medicine|, The University of Hong Kong, Hong Kong, China
2 Global Outcomes Research, Merck & Co., Inc, Whitehouse Station, USA
3 Department of Obstetrics and Gynecology, Beijing Union Medical Hospital, Beijing, China
4 Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
5 Department of Orthopaedic Surgery, Kyung Pook National University Hospital, Daegu, Korea
6 Department of Orthopaedic Surgery, Yongdong Severance Hospital, Seoul, Korea
7 University Malaya Medical Center, Kuala Lumpur, Malaysia
8 Assunta Hospital, Petaling Jaya, Malaysia
9 Gleneagles Medical Centre, Singapore, Singapore
10 Medical college, Chang Gung University, Kwei-Shan, Taiwan
11 Orthopaedics and Rehabilitation medicine, Khon Kaen University, Khon Kaen, Thailand
12 Phramongkutklao Army Hospital and College of Medicine, Bangkok, Thailand
13 Department of Orthopedics, Faculty of Medicine, Ramathibidi Hospital, Mahidol University, Maharaj Nakorn Chiangmai Hospital & Chiang Mai University, Chiang Mai, Thailand
14 The Research Partnership, Singapore, Singapore
15 Global Human Health, Outcomes Research, WS2E-76, Merck Sharp and Dohme, One Merck Drive, 08889, Whitehouse Station, NJ, USA
BMC Women's Health 2013, 13:7 doi:10.1186/1472-6874-13-7Published: 14 February 2013
A vast amount of literature describes the incidence of fracture as a risk for recurrent osteoporotic fractures in western and Asian countries. Osteoporosis evaluation and treatment after a low-trauma fracture, however, has not been well characterized in postmenopausal women in Asia. The purpose of this study was to characterize patient and health system characteristics associated with the diagnosis and management of osteoporosis among postmenopausal women hospitalized with a fragility fracture in Asia.
Patient surveys and medical charts of postmenopausal women (N=1,122) discharged after a fragility hip fracture from treatment centers in mainland China, Hong Kong, Singapore, South Korea, Malaysia, Taiwan, and Thailand between July 1, 2006 and June 30, 2007 were reviewed for bone mineral density (BMD) measurement, osteoporosis diagnosis, and osteoporosis treatment.
The mean (SD) age was 72.9 (11.5) years. A BMD measurement was reported by 28.2% of patients, 51.5% were informed that they had osteoporosis, and 33.0% received prescription medications for osteoporosis in the 6 months after discharge. Using multivariate logistic regression analyses, prior history of fracture decreased the odds of a BMD measurement (OR 0.63, 95% CI 0.45-0.88). Having a BMD measurement increased the odds of osteoporosis diagnosis (OR 10.1, 95% CI 6.36-16.0), as did having health insurance (OR 4.95, 95% CI 1.51-16.21 for private insurance with partial self-payment relative to 100% self-payment). A history of fracture was not independently associated with an osteoporosis diagnosis (OR 0.80, 95% CI 0.56-1.15). Younger age reduced the odds of receiving medication for osteoporosis (OR 0.59, 95% CI 0.36-0.96 relative to age ≥65), while having a BMD measurement increased the odds (OR 1.79, 95% CI 1.23-2.61).
Osteoporosis diagnosis and treatment in Asian countries were driven by BMD measurement but not by fracture history. Future efforts should emphasize education of general practitioners and patients about the importance of fracture.