Multimorbidity adds to clinical management complexity but its contribution to the osteoporosis treatment gap is unknown. This study aimed to determine the impact of multimorbidity on fracture risk and on osteoporosis management in high fracture risk persons.
45 and Up is a prospective population-based cohort of 267,153 people with questionnaires linked to hospital (Admitted Patients Data Collection –APDC), emergency (Emergency Department Data Collection – EDDC)[1], Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS)[2] datasets. Fractures and Charlson Comorbidity Index (CCI) were identified from APDC and EDDC, DXA investigation from MBS; osteoporosis treatment from PBS.
There were 25,280 persons with incident fracture classified in high and low risk based on 10-year Garvan fracture risk (age, sex, weight, prior fracture and falls) threshold ≥20%.
Association of CCI with fracture risk was assessed by Cox model and likelihood of investigation and treatment initiation by logistic regression.
Persons in the high risk group were significantly older and had higher CCI than those in the low risk group. Having a higher CCI and being in the high risk group were independently associated with > 2-fold risk of re-fracture. However, in the high risk group, only 28% (48% women and 17% men) were investigated and 21% (24% women and 14% men) treated. A higher CCI was associated with significantly lower probability of investigation [OR, women: 0.84 (0.79-0.89); men: 0.71 (0.62-0.81)] and treatment initiation [OR, women: 0.87 (0.82-0.94); men: 0.75 (0.66-0.85)].
Multimorbidity was associated with higher fracture risk but lower likelihood of investigation or treatment for osteoporosis. These findings suggest that fracture risk is either under-estimated or under-prioritized in the context of multimorbidity, and highlights the need for improved fracture care in this setting.
[1] Data was linked by the Centre for Health Record Linkage
[2] MBS and PBS data sets were provided by Services Australia