---
title: "Osteoporosis Treatment Initiation After Low-Trauma Fracture: Population Cohort Study in New South"
id: "pubmed-42678003"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42678003"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42678003/"
doi: "10.5694/mja2.70285"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Osteoporosis Treatment Initiation After Low-Trauma Fracture: Population Cohort Study in New South
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42678003
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42678003/)
- **DOI:** [10.5694/mja2.70285](https://doi.org/10.5694%2Fmja2.70285)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Large retrospective population-based cohort study of adults aged ≥50 years in New South Wales, Australia, using linked administrative health data to examine **osteoporosis** medicine prescribing after incident low-trauma fracture (Jan 2011–Jun 2019). - Primary outcomes: prescribing patterns and timing of treatment initiation over 3 years, categorised as early (within 12 months), late (1–3 years) or no initiation. - Cohort: 132,268 individuals with incident fractures; 63.7% female. Overall, 22.5% (29,802) initiated osteoporosis medicine and 77.5% (102,466) remained untreated within 3 years. - Sex-stratified initiation: among females (mean age 77.7 years) 20.1% initiated within 12 months, 7.0% within 1–3 years, 72.9% untreated; among males (mean age 77.2 years) 10.8% initiated within 12 months, 3.7% within 1–3 years, 85.6% untreated. - Predictors of earlier initiation (Fine–Gray competing-risk regression accounting for death): non-distal fractures, older age, polypharmacy, prior steroid use, prior DXA, and later fracture year increased likelihood of initiation. - Factors associated with lower initiation rates: greater comorbidity burden, rural/regional residence, and prior hospitalisation for falls. - Strongest associations: hip or vertebral fracture increased initiation (subdistribution hazard ratio range 1.90–3.03); high comorbidity burden decreased initiation (subdistribution hazard ratio range 0.72–0.75). - Treatment patterns changed over time: **denosumab** rapidly replaced oral **bisphosphonates** as the dominant therapy. - Safety/clinical implications: more than three-quarters remained untreated after fracture, indicating substantial gaps in **secondary fracture prevention** and need for improved post‑fracture care and long-term treatment planning given changing drug use. - Secondary finding: almost one in four late initiators experienced a refracture before starting therapy.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia. * 2 St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia. * 3 School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia. * 4 Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. * 5 North Wales Medical School, Bangor University, Bangor, Wales, UK. * PMID: **42678003** * DOI: [ 10.5694/mja2.70285 ](https://doi.org/10.5694/mja2.70285) Item in Clipboard # Patterns of Osteoporosis Treatment Initiation Following Low-Trauma Fracture: A Population-Based Retrospective Cohort Study in New South Wales, Australia, Using Linked Administrative Health Data Mike Lin et al. Med J Aust. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID Med J Aust Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Med+J+Aust%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Med+J+Aust%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42678003/) . 2026 Sep;224(9):e70285. doi: 10.5694/mja2.70285. ### Authors [Mike Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+M&cauthor_id=42678003)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-1 "Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-2 "St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia."), [Huy Nguyen](https://pubmed.ncbi.nlm.nih.gov/?term=Nguyen+H&cauthor_id=42678003)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-1 "Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-3 "School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia."), [Thach Tran](https://pubmed.ncbi.nlm.nih.gov/?term=Tran+T&cauthor_id=42678003)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-1 "Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-3 "School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia."), [Robert D Blank](https://pubmed.ncbi.nlm.nih.gov/?term=Blank+RD&cauthor_id=42678003)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-1 "Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-4 "Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."), [Dana Bliuc](https://pubmed.ncbi.nlm.nih.gov/?term=Bliuc+D&cauthor_id=42678003)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-1 "Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-5 "North Wales Medical School, Bangor University, Bangor, Wales, UK."), [Jacqueline R Center](https://pubmed.ncbi.nlm.nih.gov/?term=Center+JR&cauthor_id=42678003)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-1 "Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678003/#short-view-affiliation-2 "St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia.") ### Affiliations * 1 Bone Epidemiology, Clinical and Translational Science Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia. * 2 St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia. * 3 School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia. * 4 Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. * 5 North Wales Medical School, Bangor University, Bangor, Wales, UK. * PMID: **42678003** * DOI: [ 10.5694/mja2.70285 ](https://doi.org/10.5694/mja2.70285) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objectives:** To characterise osteoporosis medicine prescribing patterns following low-trauma fractures and identify predictors of early treatment initiation. **Study type:** Retrospective population-based cohort study. **Setting:** New South Wales, Australia, using statewide linked administrative health data. **Participants:** Adults aged ≥ 50 years with an incident low-trauma fracture between January 2011 and June 2019. **Main outcome measures:** Primary outcomes were osteoporosis treatment prescribing patterns and timing of initiation after incident fracture over 3 years, categorised as early (within 12 months), late (within 1-3 years) or no initiation. Secondary analyses examined predictors of time to treatment initiation within 12 months using Fine-Gray competing-risk regression. **Results:** Among 132,268 individuals with incident fractures, 63.7% (84,222) were female. Overall, 29,802 (22.5%) initiated osteoporosis medicine, whereas 102,466 (77.5%) remained untreated. Among females (mean [standard deviation] age, 77.7 [10.1] years), 20.1% initiated therapy within 12 months, 7.0% within 1-3 years, and 72.9% remained untreated. Among males (mean [standard deviation] age, 77.2 [10.0] years), the corresponding proportions were 10.8%, 3.7% and 85.6%. After accounting for the competing risk of death, treatment initiation was more likely with non-distal fractures, older age, polypharmacy, prior steroid use, prior dual-energy x-ray absorptiometry and later fracture year, and less likely with greater comorbidity, rural or regional residence and prior hospitalisation for falls. The strongest associations were for hip or vertebral fracture (subdistribution hazard ratio range, 1.90-3.03) and high comorbidity burden (subdistribution hazard ratio range, 0.72-0.75). Almost one in four late initiators had a refracture before starting treatment. Denosumab rapidly replaced oral bisphosphonates as the dominant therapy over time. **Conclusion:** More than three-quarters of individuals remain untreated after fracture, highlighting persistent and substantial gaps in secondary fracture prevention. Treatment initiation is strongly associated with fracture site and multimorbidity burden, and initiation rates are lower in males. Increasing reliance on denosumab underscores the need for careful long-term treatment planning and strategies. **Keywords:** comorbidities; epidemiology; fracture; osteoporosis; pharmacoepidemiology; public policy. ## Plain language summary The Known: After a fracture, the risk of another fracture is high. Osteoporosis medicines can help reduce this risk. The New: In this large study of more than 132,000 people in New South Wales, Australia, with fractures, about one in four females and one in seven males started treatment with osteoporosis medicine within 3 years. Males and people with more health problems were less likely to receive treatment. Over time, denosumab replaced oral bisphosphonates as the most common therapy. The Implications: There are major gaps in post‐fracture care, highlighting missed opportunities to prevent future fractures. Earlier treatment initiation should be a priority. © 2026 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Contemporary pharmacological management of patients after hip fracture: a population-based cohort of over 120,000 patients in Spain. ](https://pubmed.ncbi.nlm.nih.gov/40650742/) Llopis-Cardona F, Rodríguez-Bernal CL, Hurtado I, Espallargues M, García N, Gorostiza I, Gorricho J, Librero J, Millán E, Modroño G, Parraza N, Sanfélix-Gimeno G.Llopis-Cardona F, et al.Osteoporos Int. 2025 Aug;36(8):1405-1415. doi: 10.1007/s00198-025-07564-4. Epub 2025 Jul 12.Osteoporos Int. 2025.PMID: 40650742Free PMC article. * [ Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools. ](https://pubmed.ncbi.nlm.nih.gov/36945065/) Gates M, Pillay J, Nuspl M, Wingert A, Vandermeer B, Hartling L.Gates M, et al.Syst Rev. 2023 Mar 21;12(1):51. doi: 10.1186/s13643-023-02181-w.Syst Rev. 2023.PMID: 36945065Free PMC article. * [ Rates of osteoporosis screening and treatment following vertebral fracture. ](https://pubmed.ncbi.nlm.nih.gov/30142455/) Barton DW, Behrend CJ, Carmouche JJ.Barton DW, et al.Spine J. 2019 Mar;19(3):411-417. doi: 10.1016/j.spinee.2018.08.004. Epub 2018 Aug 22.Spine J. 2019.PMID: 30142455 * [ Post-fracture care and predictors of anti-osteoporotic treatment in Switzerland: a nationwide health claims analysis. ](https://pubmed.ncbi.nlm.nih.gov/41524786/) Everts-Graber J, Schmid G, Häuselmann H, Huber C, Streit S, Ravensbergen W, Reichenbach S, Maurer B, Lehmann T, Pinedo-Villanueva R, Graber SM.Everts-Graber J, et al.Osteoporos Int. 2026 Mar;37(3):691-701. doi: 10.1007/s00198-025-07832-3. Epub 2026 Jan 12.Osteoporos Int. 2026.PMID: 41524786 * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42678003) ## References 1. 1. O. Johnell and J. Kanis, “Epidemiology of Osteoporotic Fractures,” Osteoporosis International 16, n
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