Access to pharmacological management for osteoporosis in older people with hip fractures in long-term care: A nationwide cross-sectional study

Objectives To examine whether individuals who had a hip fracture while accessing long-term care (LTC) in a facility or at home, or were waiting for LTC, received recommended pharmacological management for osteoporosis before and in the year after fracture. Design A population-based cross-sectional study using the National Historical Cohort of the Registry of Senior Australians (ROSA). Setting and participants Older people hospitalised with a hip fracture while accessing or waiting for facility or home-based LTC in Australia between 01/01/2012 and 31/12/2018. Methods Utilisation of pharmacological management for osteoporosis (i.e., bisphosphonates, denosumab, teriparatide, strontium) before and one year after hip fracture was examined using linked pharmaceutical, hospital, and aged care data. Logistic regression models examined the associations between individual and LTC setting characteristics and accessing pharmacological management in the year after fracture. Results Of the 52,233 (71.3% female, 87.7 median age) hip fractures that occurred during the study period, 58.3% (n = 30,441) in were in individuals receiving facility-based LTC, 14.6% (n = 7603) were receiving home-based LTC, and 27.2% (n = 14,189) were waiting for LTC. Forty three percent (N = 22,622 of 52,233) had received pharmacological management for osteoporosis at any time prior to hip fracture and 21% received it in the previous year. One-year post fracture, 39% of the 30,768 individuals who were still alive had received pharmacological management for osteoporosis. Older age, male gender, having dementia, receiving facility-based LTC, and not receiving pharmacological management prior to fracture were associated with lower receipt of pharmacological management after fracture. Conclusions and recommendations These results highlight that the use of pharmacological management for osteoporosis for older people experiencing a hip fracture while in or waiting for LTC remains low, despite clinical guideline recommendations. Brief summary Of the 52,233 older Australians who had a hip fracture while receiving or waiting for long-term care between 2012 and 2018, 43% had received osteoporosis medication at any time prior to fracture. In the year after fracture, 39% of the 30,768 individuals who were still alive received osteoporosis medication. These national estimates highlight that access to pharmacolocical management for osteoporosis in long-term care recipients following hip fracture remains low, despite clinical guideline recommendations.