Association of Orthogeriatric Co-management with Prescription Frequencies of Anti-osteoporotic Drugs in Patients with Fragility Fractures: An Observational Study with Health Insurance Data

Background: Geriatricians are increasingly involved in the treatment of fragility fractures. In Germany, hospitals that meet specific standards for orthogeriatric co-management (OGCM) are additionally certified as 'geriatric trauma centers.' One responsibility of OGCM is the appropriate management of osteoporosis through medication. We aimed to analyse the association between prescription frequencies of anti-osteoporotic drugs in hospitals with certified OGCM, those with non-certified OGCM, and those with no OGCM at all.

Methods: Claims data from nearly 200,000 patients aged 80 and older with an incident index fracture of the humerus, forearm, hip, pelvis, or spine, were obtained from a German health insurance. Hospitals were categorized into three groups: no OGCM, with OGCM, and with certified OGCM. The outcomes were new prescriptions for specific anti-osteoporotic drugs and vitamin D within 180 days after the index fracture. Crude incidences and adjusted incidence rate ratios (IRR) were calculated.

Results: Prescription rates of specific anti-osteoporotic drugs and vitamin D increased from hospitals with no OGCM to hospitals with OGCM and were highest in hospitals with certified OGCM. This pattern was observed across all fracture types, age groups, and both men and women, except for forearm fractures. For example, in hip fractures, the IRR for prescriptions of specific anti-osteoporotic drugs in hospitals with certified OGCM compared to those with no OGCM was 2.17 (95 % CI: 1.90-2.48).

Conclusion: OGCM, especially when coupled with certification as a 'Geriatric Trauma Center,' is associated with higher prescription rates of specific anti-osteoporotic drugs and vitamin D after fragility fractures in Germany.