Patient and physician predictors of post-fracture osteoporosis management

BACKGROUND: Undertreatment of osteoporosis after hip or wrist fracture has been well documented, but the reasons for current patterns of care are poorly understood. OBJECTIVE: We tested the role of physician and patient characteristics in predicting undertreatment when osteoporosis management was clearly indicated after a hip or wrist fracture in women over age 65. METHODS: We assembled a cohort of 9,698 female Medicare beneficiaries aged >= 65 years who experienced hip or wrist fracture between 2000 and 2004 and their prescribing physicians. MEASUREMENTS: The dominant prescriber was identified as the physician prescribing at least 50% of patient prescriptions in the year after the fracture. Multivariate logistic regression estimated the role of physician and patient characteristics on osteoporosis management after hip or wrist fracture. RESULTS: Patients older than 90 and black patients were less likely to be treated for osteoporosis relative to patients aged 65-69 and white patients. Female providers were more likely to manage osteoporosis. Models including patient characteristics discriminated well between managed and unmanaged patients (C statistic 0.81), while adding physician predictors to the model provided no additional discriminatory ability (C statistic 0.81). CONCLUSIONS: Our findings highlight that osteoporosis management rates are similar across providers, but vary considerably by patient types.