Pharmacotherapy change patterns after fragility fracture in patients receiving bone-active medication: a fracture liaison service quality improvement cohort study

We examined pharmacotherapy change patterns in fragility fracture patients who fractured while taking bone active medication, and were screened by Ontario’s Fracture Screening and Prevention Program (FSPP). A secondary objective was to identify baseline characteristics associated with receiving a pharmacotherapy change recommendation. The cohort included fragility fracture patients (50 + years), who fractured while taking bone active medication, were screened by the FSPP during 2017–2024, and subsequently evaluated by bone health specialists. Descriptive statistics were used to summarize baseline factors and pharmacotherapy patterns. Factors associated with receiving a recommendation to change medication were investigated using multivariable regression. Of 828 patients meeting eligibility criteria, 60.4% (n = 500) were advised to change medication, 33.9% (n = 281) to remain on the same medication, and 2.7% (n = 22) to discontinue the medication. Data were unavailable for 3.0% (n = 25). Of those advised to change medication, 83.6% (n = 418) were changed to denosumab, 5.2% (n = 26) to teriparatide, and 2.4% (n = 12) to risedronate. Older age was associated with a higher likelihood of receiving a recommendation to change medication [1.84 (95% CI: 1.15–2.95)], while being on denosumab was associated with a lower likelihood [0.07 (95% CI: 0.05–0.11)]. Findings suggest that a fracture on treatment prompted re-evaluation and treatment escalation in many cases, while younger age and prior denosumab use were associated with lower likelihood of switching, likely reflecting a multitude of clinical considerations and jurisdiction-specific reimbursement constraints. This study provides real-world insights on pharmacotherapy change patterns in a high-risk, understudied patient cohort from a jurisdiction-wide FLS, addressing a group with therapeutic uncertainty.