Burden of Disease and Treatment Gap in Patients with an Osteoporotic Hip Fracture between 2015 and 2019 in Italy

Background: Osteoporosis (OP) represents a public health challenge, with OP fractures associated with high morbidity, mortality, and economic burden, and fracture risk increasing with age. We evaluated the treatment gap, subsequent fracture rate, and medical costs among patients with OP hip fracture in Italy. Methods: From two regional administrative databases, our retrospective cohort study included adults aged ≥ 50 years hospitalized for a first OP hip fracture (index fracture; 1 January 2015 to 31 December 2018). Study outcomes: percentage of patients not prescribed OP treatment in the 6 months following index fracture; fracture and mortality rates (mortality data only available for one region), direct medical costs, persistence and adherence to OP treatment in the 12 months following index fracture (follow-up). Results: Of 23,961 eligible patients, 87.8% (n = 21,028) were not prescribed OP treatment in the 6 months post-index fracture, with low 12-month persistence (33.7%) and adherence (9.6%) among treated patients. During follow-up, fracture and mortality rates were 36.9 and 280.9 per 1000 patient-years, respectively; higher in non-treated versus treated (39.3 versus 24.0 and 303.7 versus 126.7) patients. Mean (SD) cost per patient was €4963 (€5509); higher in non-persistent versus persistent patients (€5832 versus €4817). Conclusions: Among patients from two Italian regions experiencing a first hip fracture, we observed a large treatment gap, and high subsequent fracture rates and medical costs. Considering fracture risk increases with age and a globally aging population, these costs are likely to increase and pose a substantial burden on the Italian health service.