LAUSR

Dear Editor, Although osteoporosis assessment and treatment after a fracture is key to preventing a second fracture in older adults, under-treatment is a concern worldwide [1, 2]. Multiple attempts have been made to bridge the gap between the event of fracture and osteoporosis evaluation [3, 4]. Bisphosphonates are often used as first-line therapy for osteoporosis. Nevertheless, there are concerns regarding their long-term use [5], and there is little information available on which medication is prescribed after fractures. Thus, we attempted to analyze data on osteoporosis prescriptions in post-fracture patients utilizing an administrative database. Yokohama Original Medical Database is based on healthcare bills sent from medical institutions to the public medical payment fund. Yokohama has a population of 3.7 million, and the database includes approximately 86% of citizens over the age of 65 years. We extracted patient data of those over 65 years old with a history of fracture between October 2014 and March 2015. We excluded patients who underwent osteoporosis treatment before the fracture. Osteoporosis treatment was defined as a prescription in any of the following categories: bisphosphonate, selective estrogen receptor modulator, parathyroid hormone, calcitonin, activated vitamin D3, menatetrenone, and denosumab. Of the 13,758 medical records, prescriptions for osteoporosis were confirmed in 2386 (17.3%) patients within 3 months of fracture. Specifically, initiation of treatment in those aged 65–69 years was notably low in 263 of 1764 (14.9%) patients. These age groups also showed a low rate of bisphosphonate prescription compared to other age groups (Table 1). Additionally, males were less likely to be treated than females (9.6% vs. 21.2%, data not shown). In the present study, we demonstrated real-world data of post-fracture osteoporosis treatment in older adults. Only 17.3% of patients who had experienced a fracture were initiated on treatment for osteoporosis. Considering that the patients in this study were over 65 years old with a history of fracture, the rate of treatment seems inadequate. This result is in accordance with a study based on a nationwide survey in Japan which reported that only onethird of women with an established diagnosis of osteoporosis were treated [6]. Additionally, we found that those aged 65–69 years had a significantly low rate of treatment initiation. The absolute number of prescriptions for bisphosphonates was also low in this age group. We speculate that clinicians might be hesitant to initiate bisphosphonate treatment because of concerns regarding the adverse effects of long-term use, as reported by a previous study [7]. The strength of the current investigation is the comprehensiveness of the data from a populous and aging city. Moreover, to the best of our knowledge, this is the first administrative data analysis to look at the types of medication used for post-fracture osteoporosis. Administrative data analysis has its own limitations [8]. Since the original data were collected for financial management, the clinical validity of it is uncertain. However, each medication was tracked from the prescription itself. We believe that monitoring the trends in osteoporosis medication use is a valuable approach to provide insight into possible undertreatment. * Y. Yamamoto [email protected]