Treatment gaps in osteoporosis care following recurrent fractures: a nationwide cohort study
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: This nationwide cohort study primarily aimed to descriptively characterize real-world treatment patterns, including treatment initiation, adherence, treatment duration and discontinuation of the first treatment drug, among patients who experienced a recurrent osteoporotic fracture. Materials & methods: This population-based, retrospective cohort study used data from the Health Insurance Review and Assessment Database of South Korea. It included male and female patients aged 55 years and older who experienced a recurrent osteoporotic fracture within 2 years of their index fracture in 2013. Results: The study period was from 1 January 2012 to 31 December 2021, with an outcome assessment period from 1 January 2013 to 31 December 2017. A total of 34,558 patients with recurrent osteoporotic fractures were observed, and just over half (n = 18,462, 53.4%) received osteoporosis medication, with a significant difference in medication rates between males (23.7%) and females (58.8%) (p < 0.001). The estimated median duration of osteoporosis medication was 146 days (interquartile range: 61–365 days). The discontinuation rate of medication within 2 years of follow-up after their recurrent fracture was 80.5%, with the highest discontinuation rate (90.4%) observed among patients taking daily oral bisphosphonate medication. Conclusion: Although patients with recurrent fractures require intensive management, our results showed a significant unmet need in the initiation and persistence of osteoporosis medication. Therefore, it is crucial to establish a strategic treatment approach to address the treatment gap in managing osteoporosis among very high-risk patients. Dataset name: Health Insurance Review and Assessment Database of South Korea.
Plain language summary: Do people get the right osteoporosis treatment after breaking a bone again? A study using national insurance claim data from Korea
What is this article about?
This article examines whether people with osteoporosis who have more than one bone fracture are receiving the treatment they need. We focused on how many patients started osteoporosis medications, how long they stayed on the medication, and how often they stopped treatment too early. Since people who have more than one fracture are at very high risk for future breaks, it is important to understand if they are being treated properly.
What were the results?
We used health insurance data from South Korea to study over 34,000 people aged 55 and older who had a second fracture within 2 years of their first one. Only about half of these patients received osteoporosis medication after the second fracture. Many stopped taking their medicine within a few months. Two years later, more than 80% had stopped their first osteoporosis medication. The worst rates of stopping medication were seen with daily oral pills.
Why is this important?
Osteoporosis is a treatable condition, and people who have already had fractures are at the highest risk for more. This study shows that many patients are not getting or continuing the treatment they need. Better support and follow-up are needed to prevent future fractures in these high-risk individuals.
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© 2026 The authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
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Received: 8 February 2026
Accepted: 23 June 2026
Published online: 3 August 2026
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Treatment gaps in osteoporosis care following recurrent fractures: a nationwide cohort study. (2026) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2026-0039
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