NHS guidance leads to reduction of repeat hip fractures

The adoption of new guidance on osteoporosis medication in 2005 may have been responsible for a 22% drop in the number of over-60s suffering a second fracture after a broken hip, an Oxford University study, published in the Journal of Bone and Mineral Research, has found.

Researchers reviewed patient data from GP practices across England and Wales to see whether new guidance issued by the National Institute for Health and Care Excellence (NICE) in January 2005 had had an effect on doctors’ practice and on patients’ health. The study was funded by the National Institute for Health Research Health Services and Delivery Research programme.

The 2005 document recommended that bisphosphonates, which slows or stop the natural process that dissolves bone tissue and thus maintains or increases bone density and strength, be given to postmenopausal women with osteoporosis who had had a fracture linked to the osteoporosis. It was followed in August 2005 by a common bisphosphonate treatment – alendronic acid – becoming available as a much cheaper generic drug (Currently about £12/year).

The study of almost 11,000 patients focussed on those who had had a hip fracture between 1999 to 2012, comparing what happened following the introduction of guidance and availability of common bisphosphonate treatment in 2005 to what would have happened had these events not occurred. In 1999, just 5.7% of people got bisphosphonate within 12 months of the hip fracture; in 2011, it was 50.9%. In 1999, around 5.0% got bisphosphonate between 10 and 14 months after the fracture; in 2011, it was 39.4%.

Senior Author, Associate Professor Andrew Judge of the NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, stated: ‘It is clear that the guidance coupled with the availability of a low cost bisphosphonate treatment drove a major change in prescribing by GPs. It is unclear how much this was due to the new guidance and how much due to generic alendronic acid arriving on the market, but it is notable that prescriptions for alendronic acid clearly outstrip those for other treatments, suggesting that it had a part to play.’

The team also found that the rate of subsequent major fractures fell from 5.8% in 1999 to 4.6% in the first six months of 2010. In 1999, 3.1% of patients could expect a second hip fracture within three years. In early 2010 this had fallen to 1.9%.

Lead Author, Samuel Hawley, NDORMS, University of Oxford, said: ‘While we cannot prove that the change in guidance and the availability of a cheap treatment are the direct causes of this reduction in subsequent fractures, it seems likely that these changes did have a part to play in reducing these debilitating and demoralising injuries.’

For more information, or to request a copy of the paper, please contact the University of Oxford News Office on +44 1865 270046 or [email protected]

The paper, Anti-osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis, is published in the Journal of Bone and Mineral Research.