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PLoS One. 2015 Dec 2;10(12):e0143842. doi: 10.1371/journal.pone.0143842. eCollection 2015.

Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study.

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Pôle Information Médicale, Evaluation, Recherche, Hospices Civils de Lyon, Lyon, France.
Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.
Département d'épidémiologie, hygiène hospitalière et santé publique, Centre Hospitalier Universitaire d'Amiens, Amiens, France.
INSERM U1033, Lyon, France.
Département de l'Information Médicale, Groupe Hospitalier Sud Réunion, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, France.
Department of Physical Therapy, Toronto Rehabilitation Institute-UHN Chair, University of Toronto, Toronto, Canada.
Service de Rhumatologie et de Pathologie Osseuse, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.


Treatment initiation rates following fragility fractures have often been reported to be low and in recent years numerous programs have been implemented worldwide to increase them. This study aimed at describing osteoporosis (OP) treatment initiation in a representative sample of women who were hospitalized for a distal forearm fracture (DFF) or proximal humerus fracture (PHF) in 2009-2011 in France. The data source was a nationwide sample of 600,000 individuals, extracted from the French National Insurance Healthcare System database. All women aged 50 years and older who were hospitalized for a DFF or PHF between 2009 and 2011 and who had not received any OP treatment in the preceding 12 months were included in a retrospective cohort study. OP treatments initiated during the year following the fracture were analyzed. From 2009 to 2011, 729 women were hospitalized for a DFF or a PHF and 284 were on OP treatment at the time of the fracture occurrence. Among the 445 women who had no prevalent OP treatment, 131 (29.4%) received supplementation treatment only (vitamin D and/or calcium) and 42 (9.4%) received a pharmacologic OP treatment in the year following their fracture. Pharmacological OP treatments included bisphosphonates (n = 21), strontium ranelate (n = 14), hormone replacement therapy (n = 4), or raloxifene (n = 3). General practitioners prescribed 75% of initial OP treatments. Despite the guidelines published in 2006 and the numerous initiatives to promote post-fracture OP treatment, OP treatment initiation rate in women who were hospitalized for a fragility fracture remained low in 2009-2011 in France.

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