Post-fracture care and predictors of anti-osteoporotic treatment in Switzerland: a nationwide health claims analysis.

UNLABELLED: This retrospective study using Swiss health insurance claims data found that 88% of hip and 77% of vertebral fracture patients did not receive osteoporosis treatment within 6 months post-fracture. PURPOSE: The treatment gap in osteoporosis in Switzerland has previously been estimated at 83% based on T-scores and/or FRAX thresholds. However, real-world data on treatment rates following fractures remain limited. This study analysed treatment rates and their predictors in hospitalised patients aged ≥ 50 years with recent vertebral, hip or other fractures and the associated direct economic burden. METHODS: This retrospective cohort study utilised claims data from the largest Swiss health insurance provider. The incidence of vertebral, hip and other fractures was assessed by age and sex, and treatment rates and predictors of anti-osteoporotic therapies at 12 months post-fracture were analysed. Additionally, hospitalisation duration, associated costs and care trajectories (nursing home placement, rehabilitation, home care services) were described for each fracture site, as well as mortality within 12 and 24 months post-fracture. RESULTS: From 2021 to 2023, there were 2458 vertebral, 6229 hip and 11,314 non-hip, non-vertebral fractures (59%, 70% and 74% in women, respectively). Inpatient rehabilitation was required in 8-11% of cases, and 18-21% of patients newly transitioned to nursing home placement within 3 months post-fracture. DXA scans were performed within 12 months in 10% of hip and 21% of vertebral fracture patients and represented the strongest predictor of treatment initiation (odds ratio 10.2, 9.1-11.5), with female sex, older age and greater comorbidity showing weaker effects. Treatment rates within 6 months post-fracture were 11.7% for hip fractures (including 5.0% denosumab, 2.6% zoledronate, 2.1% alendronate), 23% for vertebral fractures (including 9.4% denosumab, 4.7% zoledronate, 3.6% ibandronate, 2.7% anabolic agents) and 12.5% for other fractures, with 8%, 13% and 11% of patients, respectively, already receiving osteoporosis therapy prior to the fracture. CONCLUSION: Osteoporosis treatment rates after hip and vertebral fractures were low, with 88% and 77% of patients, respectively, not receiving treatment within 6 months. DXA scans, specialist consultations and comorbidity burden were the strongest predictors of post-fracture treatment, highlighting key patient- and system-level factors that could guide interventions to close the treatment gap.