gms | German Medical Science

28th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

11.11. - 12.11.2021, digital

Guidelines for drug therapy after osteoporosis-associated bone fractures: to what extent are they followed in everyday practice?

Meeting Abstract

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 28. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. sine loco [digital], 11.-12.11.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc21gaa04

doi: 10.3205/21gaa04, urn:nbn:de:0183-21gaa042

Published: November 10, 2021

© 2021 Eichler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background: Fragility fractures impose a considerable burden on individuals as well as health care systems [1]. The German AWMF guideline (Dachverband Osteologie e.V. 2017) on prevention, diagnosis and treatment of osteoporosis recommends medical treatment in cases of higher risk of fractures. Borgström et al. 2020 estimate the treatment gap in six European countries to account for 73% of eligible female and 63% of male patients. McCloskey et al. 2021 found in a study covering eight European countries that about 75% of women over the age of 70 in primary care who were at high risk of osteoporosis-related fractures did not receive appropriate medication. Solomon et al. 2014 examined claims data in the U.S. between 2002 and 2011 and saw that only one third of postmenopausal women experiencing hip fracture received medication during the following 12 months. Our objective was to examine treatment rates for a large German cohort in 2018–2019 (pre-pandemic) using claims data retrospectively.

Materials and Methods: The proportion of patients receiving osteoporosis medication was determined in a cohort of AOK-insured patients aged 50 years or older with hospitalisation in 2018 because of fractures of any kind and osteoporosis diagnosis (M80–M82). We excluded patients who had received medication influencing bone metabolism (osteoporosis medication as well as calcium/vitamin D and hormone replacement therapy) during 365 days before hospital admission. Follow-up started at hospital admission and observation times were right-censored due to death, end of insurance or end of study period after 365 days, whichever occurred first.

Results: 27 528 patients were initially selected based on the inclusion criteria, 13 605 patients were excluded because of previous medication or non-continuous AOK insurance during the preceding two years, and 357 patients were excluded due to death or end of insurance before hospital discharge. The final cohort comprised 13 566 patients (83% female, 17% male; median age at hospitalization 84 years). In patients without medication after fracture, follow-up was complete (365 days) in 75.5%, 24.0% died and 0.5% were censored due to end of insurance. Within 365 days after hospitalisation due to fracture, 18.1% received specific osteoporosis medication and 36.4% any medication influencing bone metabolism. Treatment rates were slightly higher in females compared to males (36.7%/34.7% respectively) and decreased with higher age (42.7% in patients up to 79 years of age/33.7% in patients aged 80 and older). Also, treatment rates decreased with rising care level and were especially low in patients living in nursing homes (18.1%). Treatment rates were higher after vertebral fractures compared to hip and other fractures (48.0%/33.9%/33.4% respectively). Furthermore, treatment rates were similar for patients living in urban compared to rural areas.

Conclusion: In spite of guideline recommendations, medical treatment rates after osteoporosis-related bone fractures remain low in Germany. This result is in line with previous findings on German practice by e.g. Hadji et al. 2020 (37% treatment rate with medication of all kind after bone fracture in 2016) or Borgström et al. 2020 (20% treatment rate considering osteoporosis specific medication for eligible patients in 2017).


Borgström F, Karlsson L, Ortsäter G, Norton N, Halbout P, Cooper C, Lorentzon M, McCloskey EV, Harvey NC, Javaid MK, Kanis JA; International Osteoporosis Foundation. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020 Apr;15(1):59. DOI: 10.1007/s11657-020-0706-y External link
Dachverband Osteologie e.V. German guideline “Prophylaxe, Diagnostik und Therapie der Osteoporose”; 2017. Available from: External link
Hadji P, Hardtstock F, Wilke T, Joeres L, Toth E, Möckel L, Gille P. Estimated epidemiology of osteoporosis diagnoses and osteoporosis-related high fracture risk in Germany: a German claims data analysis. Arch Osteoporos. 2020 Aug;15(1):127. DOI: 10.1007/s11657-020-00800-w External link
McCloskey E, Rathi J, Heijmans S, Blagden M, Cortet B, Czerwinski E, Hadji P, Payer J, Palmer K, Stad R, O’Kelly J, Papapoulos S. The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study. Osteoporos Int. 2021 Feb;32(2):251–9. DOI: 10.1007/s00198-020-05557-z External link
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res. 2014 Sep;29(9):1929–37. DOI: 10.1002/jbmr.2202 External link