Osteoporosis and OFs (i.e., DRFs, HFs, spine, and humerus fractures) are becoming more important health problems in the elderly [13]. OFs reduce quality of life and cause medical expenses in the elderly [14, 15].
DRFs occur mostly in individuals in their 50 s and 60 s and are predictive of a risk for secondary OF. Nevertheless, they tend to be less important than hip and spine fractures because of their lower morbidity and mortality [8, 16, 17]. DRFs are the second most common OFs in Korea [18, 19]. As background for the FLS, 50% of the patients who had HFs reported having other fractures, which could be called signal fractures, before their HFs [20, 21]. This means that osteoporosis management after DRFs could be an important intervention to prevent subsequent OFs.
In 2010, 9.9% of HFs, 19.3% of spine fractures, and 5.5% of proximal humerus fractures were managed with osteoporosis medications [22]. Jung et al. analysed the prescription rate of osteoporosis medications after a first OF in Korea from 2008 to 2012 and found that only 19% of men and 42% of women began anti-osteoporosis treatment within 6 months after a first fracture [23]. The percentage of medication use for osteoporosis within 6 months post-DRF was 3.5% in men and 21.9% in women. Among HF patients, 20.1% of men and 45.9% of women received osteoporosis medications. In total, osteoporosis was managed in 18.9% of DRFs and 37.9% of HFs after fractures.
Our study revealed that from 2011 to 2016, 17.2% of DRF cases received osteoporosis medication within 6 months post-fracture, whereas 34.5% of HF cases did. Compared to a previous study, we observed a slightly lower prescription rate for osteoporosis medication, but not a big difference. The trend in the prescription rate showed a slight, but significant, decreasing tendency.
As in previous studies [23, 24], females were more likely than males to receive osteoporosis medication after DRFs and HFs. The rate of treatment was highest for those in their 70 s for both DRFs and HFs, as was a diagnosis of osteoporosis [10]. Similarly, young males were least likely to receive osteoporosis treatment in our study. Some studies have reported that men who are referred for osteoporosis tend to be with more severe osteoporosis [25], and the mortality rate related with HFs is higher in men than in women [26]. Therefore, physicians need to take care of young males with OFs, particularly DRFs.
The HF patients received more osteoporosis medications in tertiary hospitals, while the DRF patients who were treated in hospital received more medications than those seen at other medical facilities. This might result from the disease entity. Patients with an HF tend to be older and have more comorbidities and complications.
Bisphosphonates were mostly used; however, a gradual increase in the use of SERMs was observed, particularly in DRF patients. Although both DRFs and HRs are OFs, the T-score of bone mineral density sometimes exceeded − 2.5. This might be more common in DRFs because DRF patients are younger than HF patients. The increased use of SERMs might result from OFs in individuals with T-scores > − 2.5. Because complications of long-term bisphosphonate use are emerging, such as atypical femur fractures [27–29] and osteonecrosis of the jaws [30, 31], many clinicians think that the early use of bisphosphonate might not be ideal.
This study had several limitations. First, the incidence rates of DRFs and HFs calculated based on a medical claims database might be underestimated, in common with previous reports using medical claims databases. Second, we do not know whether the patients actually took the prescribed pills because our study was based on a claims database. Third, the healthcare system can affect the kinds of pills prescribed. Until 2016, parathyroid hormone and denosumab were permitted under very limited conditions. Since then, neither has been allowed for several conditions, so these two medications might have been used more before 2016.