Trends in risk of subsequent fracture and post-fracture treatment among post-menopausal US women.

Background

Osteoporotic fractures are common among postmenopausal women and are associated with mortality, functional decline, and reduced quality of life. Despite elevated risk of subsequent fractures, post-fracture treatment initiation remains low. This study evaluated subsequent fracture risk and treatment initiation among postmenopausal women in the US.

Methods

A retrospective cohort study using the Optum© Clinformatics® Data Mart administrative claims database identified US women aged ≥50 years with an incident clinical fracture between 2012 and 2021, with follow-up through December 2023. The primary outcome was subsequent fracture occurring ≥90 days after the index fracture; secondary outcomes included subsequent fracture at the hip/femur or spine and initiation of pharmacologic osteoporosis treatment. Cumulative incidence at 6, 12, and 24 months was estimated using an inverse probability weighted estimator, with stratification by index fracture site, prior osteoporosis diagnosis, and age.

Results

A total of 467,721 women with an incident fracture were identified; median age at index fracture was 76 years. The 24-month cumulative risk of subsequent fracture was 19.4% overall, with the highest risk observed in women with an index spine (27.8%) and pelvic fracture (24.2%). Subsequent fracture risk was higher in women with a prior osteoporosis diagnosis and increased with age. Treatment initiation by 24 months was 17.5%, with 64% of treatments occurring within the first six months.

Conclusions

In this large national cohort, subsequent fracture risk was high, yet treatment initiation remained low. These results highlight a persistent gap between elevated subsequent fracture risk and treatment initiation in contemporary US post-fracture care.