Osteoporosis medication initiation after proximal humerus fractures is low, but associated with decreased secondary fragility fracture risk

OBJECTIVES: To 1) identify factors associated with osteoporosis medication (OPM) prescription after proximal humerus fractures and 2) evaluate rates of secondary osteoporotic fragility fracture (OFF) between patients treated with OPM vs those who were not. DESIGN: Retrospective cohort analysis. SETTING: TriNetX Health Research Network. PATIENT SELECTION CRITERIA: Patients aged 60 years or older who sustained a proximal humerus fracture (PHF) (OTA/AO 11) between 2005 and 2025 were categorized into groups based on if they were or were not prescribed OPM within 1 year after a PHF. OUTCOME MEASURES AND COMPARISONS: The primary outcome was prescription of OPM after PHF. Patient demographics were assessed between patients who were or were not prescribed OPM. Pairwise comparisons of proportions were performed using two-proportion Z-tests with Bonferroni correction. A matched cohort analysis was conducted to assess rates of secondary OFF after PHF. Measures of association models were used to determine odds ratios (OR). RESULTS: A total of 180,304 patients with PHFs were identified, with 6627 (3.7%) patients prescribed OPM after a PHF. Female patients were more likely to be prescribed OPM (84.6% vs 68.0%, P < 0.001). Black patients were less likely to be prescribed OPM (2.7% vs 5.1%, P < 0.001). After matching, patients who were prescribed OPM after a PHF had a decreased 1-year mortality rate (OR = 0.79; 95% confidence interval, 0.66-0.94; P = 0.008) and lower rate of secondary fragility fractures (OR = 0.63, 95% confidence interval, 0.56-0.72; P < 0.001). CONCLUSIONS: Osteoporosis medications are not commonly initiated after geriatric PHFs. OPM initiation after PHF was associated with lower rates of secondary OFF and 1-year mortality. LEVEL OF EVIDENCE: Level III, Prognostic.