Real-world osteoporosis management before and after sustaining fragility fractures in Japanese older adults aged ≥ 75 years: Japanese bone-fracture osteoporosis in late-stage population database (J-BOLD) study.
BACKGROUND As the population ages, the incidence of fragility fractures increases; however, large-scale data on real-world osteoporosis management in late-stage older adults (aged ≥75 years)-a group at extremely high risk of fractures-are limited in Japan. In this study, we aimed to clarify the status of osteoporosis management in this high-risk population, using a large-scale administrative claims database. METHODS This retrospective cohort study used data from the DeSC database. We identified 405,416 patients aged ≥75 years with an initial fragility fracture at a major osteoporotic site (the hip, vertebrae, humerus, radius, pelvis, ribs, etc.) between 2014 and 2022. We assessed osteoporosis medication prescription and diagnostic testing (bone mineral density and bone turnover markers) rates in the pre-fracture (day -180 to -1), early post-fracture (day 0-90), and late post-fracture (day 91-365) periods. RESULTS The mean age of the cohort was 84.3 years, and 73.0% were women. The medication prescription rate was 25.0% in the pre-fracture period, increasing only slightly to 27.5% during the early post-fracture period and 28.5% during the late post-fracture period, leaving over 70% without a prescription. Annual data from 2016 to 2021 showed that post-fracture prescription rates remained consistently low, with little change over time. A marked disparity in prescription rates by fracture site was observed, with late post-fracture prescription rates of 36.7% for vertebral fractures and 20.4% for hip fractures. Even when stratified by age group, prescription rates remained consistently low among patients with hip fractures. CONCLUSIONS This large-scale, real-world study showed that many patients aged ≥75 years remained untreated after an initial fragility fracture. Prescription rates were particularly low among patients with hip fractures, despite their expected high risk of subsequent fractures. These findings highlight the need for strategies to improve diagnosis and treatment in this vulnerable population.