Spine - 2026-06-15 - Journal Article
Bone Health Medication Following Low Energy Thoracic and Lumbar Fractures.
Striano BM, Crawford AM, Holly KE, Gu AW, Hatton MO, Lightsey HM, Schoenfeld AJ
Topics
Key Takeaway
Only 10% of patients ≥50 years old with low-energy thoracic or lumbar fractures received appropriate bone health medication within 90 days, with surgical intervention conferring a 3.35-fold increase in treatment odds.
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Summary
This study quantified the rate of osteoporosis treatment initiation after low-energy type A thoracic and lumbar fractures in patients ≥50 years at four centers from 2015–2021. Treatment success—defined as de novo initiation, addition of a new agent, or switch within 90 days—occurred in only 41 of 409 patients (10%). On multivariable logistic regression, surgical intervention was the sole independent predictor of treatment receipt (OR 3.35, 95% CI 1.42–7.58, p=0.003).
Key Limitation
Single health system data limits generalizability, and the retrospective design cannot exclude that some patients received treatment recommendations outside the system that were not captured in the medical record.
Original Abstract
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To characterize the success rate of anti-osteoporosis treatment for patients with spine fracture that otherwise confers eligibility for treatment. We also evaluated factors associated with successful initiation of treatment.
SUMMARY OF BACKGROUND DATA
Thoracic and lumbar spine fractures in patients 50 years of age or older after low-energy injuries confer a diagnosis of osteoporosis and indicate eligibility for bone health treatment. Despite this, there is little information available regarding the extent to which these patients receive appropriate treatment and the underlying factors that influence this decision.
MATERIALS AND METHODS
We included patients 50 years of age or older treated at one of four medical centers within a single system for type A thoracic or lumbar spine fractures from low-energy trauma between 2015 and 2021. Clinical, radiographic, sociodemographic, and medication data were abstracted from the medical record. Patients were noted to have successful treatment if they had de novo initiation of bone health treatment, addition of a new bone health agent to a prior osteoporosis regimen, or switched between anti-osteoporosis agents within 90 days (90 d) of injury. Bivariate statistics and logistic multivariable regression were utilized to identify factors associated with successful osteoporosis treatment while adjusting for potential confounders.
RESULTS
In total, 409 patients with complete data and 90 days of follow-up were included. Only 41 (10%) patients had successful treatment initiation of bone health medications. In both bivariate and multivariable analyses, surgical intervention was the only factor significantly associated with bone health treatment. Patients treated with surgery demonstrated a more than 3-fold increase in the odds of receiving osteoporosis treatment (OR: 3.35, 95% CI: 1.42-7.58, P =0.003).
CONCLUSION
Appropriate osteoporosis treatment after low-energy spine fracture was uncommon in our cohort, occurring in just 10% of patients. Active engagement on the part of spine surgeons increased the likelihood of receipt of bone health medications. This may represent a scalable intervention that can improve patient care.
LEVEL OF EVIDENCE
Level III.