Impact of In-Hospital Osteoporosis Treatment on Post-discharge Medication Continuity in Osteoporotic Fracture Patients: Implications for Care Continuity

Abstract

Background: Despite the well-established benefits of osteoporosis medication in reducing the risk of secondary fractures and mortality, post-fracture treatment rates remain suboptimal. The hospitalization period represents a critical opportunity to initiate therapy, yet the impact of in-hospital osteoporosis treatment on long-term adherence has not been fully evaluated in the Korean population. Methods: This retrospective cohort study used data from the National Health Insurance Service sample cohort in South Korea. Patients aged >= 50 years who were hospitalized for osteoporotic fractures, including surgically and conservatively managed cases, between 2007 and 2019, were included. The primary exposure was receipt of osteoporosis medication during hospitalization, and the primary outcome was medication continuation within 1 year post-discharge. Log-binomial regression models were used to estimate adjusted risk ratios (aRRs) for post-discharge medication continuation, adjusted for demographic, socioeconomic, and clinical variables. Subgroup analyses were conducted by age, sex, fracture site, income level, and residential region. Results: Of 19,021 patients with osteoporotic fractures, 25.9% received osteoporosis treatment during hospitalization. The 1-year post-discharge medication rate was 75.8% in the treatment group, compared to 25.4% in the non-treatment group. The aRR for post-discharge medication continuation was 2.23 (95% CI, 2.14-2.32). Similar effects were observed for both oral (aRR, 2.26) and injectable (aRR, 2.13) medications. Subgroup analysis revealed stronger associations in males (aRR, 5.01), younger patients (50-70 years; aRR, 2.93), and those with minor fractures (aRR, 3.22). Although the overall continuation rate was lower in older adults and patients with major fractures, in-hospital treatment was still positively associated with improved adherence. Conclusions: In-hospital initiation of osteoporosis medication was associated with improved post-discharge treatment continuity in patients with osteoporotic fractures. Incorporating structured osteoporosis management into inpatient orthopedic care pathways may help enhance long-term adherence and support secondary fracture prevention.