Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis

Anum Ali; Ella Huszti; Shahryar Noordin; Usman Ali; Joanna E M Sale

doi:10.1007/s00198-024-07078-5

Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis

Osteoporos Int. 2024 May 14. doi: 10.1007/s00198-024-07078-5. Online ahead of print.

Authors

Anum Ali¹, Ella Huszti², Shahryar Noordin³, Usman Ali³, Joanna E M Sale^{2

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Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada. Anum.asifhakimali@mail.utoronto.ca.
² Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada.
³ Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan.
⁴ Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
⁵ Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 5th Floor - 149 College Street, Toronto, ON, M5B 1W8, Canada.

PMID: 38740589
DOI: 10.1007/s00198-024-07078-5

Abstract

Purpose: This systematic review seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location.

Methods: We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out a single group proportional meta-analysis. We also extracted the proportions of patients who received a prescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions.

Results: This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes.

Conclusion: Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.

Keywords: Disparities; Fragility fracture; Secondary fracture prevention programs.

Publication types

Review