Comorbidities and Characteristics of Men with Subsequent Osteoporotic Fracture: A Real-world Observational Study

Objective:
Real-world data suggest that after an incident fracture, there is an increased risk of subsequent osteoporotic (OP) fractures and higher mortality in men compared to women, particularly in the first and second year after the sentinel event. Evaluation of patient characteristics associated with subsequent fractures after a previous fracture will help inform providers and enable early targeted treatment to reduce the disease burden in this population.

The study objective was to characterize men with OP in a real-world clinical practice setting who sustain a subsequent fracture within 1 or 2 years of index fracture.

Methods:
This study used anonymized patient-level data from Symphony Health PatientSource® and included men ≥40 years of age who had a fracture anytime between September 2011–May 2022 without prior evidence of cancer (except nonmelanoma skin cancer). Medical and pharmacy claims data prior to index fracture were used to identify comorbidities and medications associated with an increased risk for falls or fractures, or those with the potential to compromise bone quality/healing.

Results:
Among the patients who met study inclusion criteria, 12.7% (292,421) and 16.7% (338,386) had a second fracture within the first or within the second year after index fracture, respectively. The majority of men were ≥65 years of age: 52% (n=153,038) and 52% (n=176,060) had a fracture within 1 and 2 years after index fracture, respectively. Patients with a second fracture had comorbidities or were taking medications associated with increased risk of falls. A higher rate of Parkinson’s (39.2%), dementia (38.3%), Alzheimer’s (36.2%), muscle weakness/atrophy (27.8%), and stroke (27.2%) was observed for commercial enrollees who refractured. Comparable results were observed in the Medicare Advantage enrollees. The prevalence of cardiovascular disease (>75%), hypertension (>64%), diabetes (>30%), history of falls (>31%), and impaired mobility (>29%) for refractured patients was high but comparable to the overall population. A third of patients in both cohorts used oral corticosteroids, and almost three-quarters had ≥1 prescriptions for opioids.

Discussion/Conclusion:
The majority of patients with subsequent fractures have a high comorbidity burden, including cardiovascular disease and conditions associated with impaired mobility. Many men are also on medications associated with an increased risk of falls and fractures.