Impact of a national reimbursement add-on policy on refracture risk and secondary fracture prevention after hip fracture in Japan: a population-based interrupted time series analysis

In Japan, a national reimbursement add-on for secondary fracture prevention after hip fracture surgery, implemented on April 1, 2022, was associated with lower 1-year refracture risk and higher early uptake of post-fracture DXA assessment within 90 days and anti-osteoporosis medication initiation within 120 days, but not with improved 1-year post-fracture treatment persistence. PURPOSE: To assess whether the Japanese national reimbursement add-on policy for preventing secondary fracture after hip fracture surgery, introduced in April 2022, was associated with actual changes in refracture risk and key secondary fracture prevention care processes after hip fracture surgery. METHODS: We conducted a population-based interrupted time-series analysis using longitudinal health insurance claims data collected in Japan between 2019 and 2023. Participants were adults aged ≥ 50 years with newly identified and surgically treated hip fracture. The intervention was implementation of the policy on 1 April 2022. Outcome measures were absolute changes 12 months after policy implementation in the 1-year cumulative risk of first refracture, 90-day cumulative probability of receiving dual-energy X-ray absorptiometry (DXA) assessment, 120-day cumulative probability of initiating anti-osteoporosis medication, and 1-year post-fracture treatment persistence. RESULTS: Twelve months after policy implementation, the absolute effect on the 1-year cumulative risk of refracture in the hip fracture series was - 1.02 percentage points (95% confidence interval, - 1.44 to - 0.60). The absolute effects on early care processes were 41.37 percentage points (40.21 to 42.54) for DXA assessment and 22.83 percentage points (21.70 to 23.95) for the initiation of anti-osteoporosis medication. The absolute effect on 1-year post-fracture treatment persistence was - 6.76 percentage points (- 10.04 to - 3.49). CONCLUSIONS: The reimbursement add-on policy for secondary fracture prevention after hip fracture surgery was associated with a lower 1-year cumulative refracture risk and a higher cumulative probability of receiving DXA assessment and initiating anti-osteoporosis medication, but not with improved 1-year post-fracture treatment persistence. Strategies supporting sustained follow-up and reengagement may be needed.