001  Very obese 0.462 <0.001 0.394 <0.001 0.357 <0.001 Missing 0.726 <0.001 0.710 <0.001 0.701 <0.001 Charlson Comorbidity Index 0.955 <0.001 0.963 <0.001 0.968 <0.001 Oral corticosteroid Selleckchem VE822 1.338 <0.001 1.336 <0.001 1.309 <0.001 Rheumatoid arthritis 1.395 <0.001 1.512 <0.001 1.732 <0.001 BMI body mass index, BMD bone mineral density, ICD-9 International Classification of Diseases 9 Discussion The purpose of this study was to quantify how fracture risk factors are associated with physicians prescribing bisphosphonate treatment in women with post-menopausal osteoporosis. The treatment rate was low, especially in the

FRAC group, with merely 9.4% having a prescription order for an oral bisphosphonate in the first 90 days following a fracture and only 18.5% having such a prescription order if the follow-up period is extended to 1 year. This result is similar to those found in other studies where treatment rates have ranged from 16% to 26% in patients with fractures during 1 year follow-up periods [7, 27–30]. The rate of treatment within 90 days of diagnosis in the ICD-9-BMD group was also low (41.6%), and

remained low at 1 year after diagnosis of osteoporosis (49.3%). These treatment rates all fall short of the estimates based on National Osteoporosis Foundation (NOF) https://www.selleckchem.com/products/tideglusib.html guidelines [31]. Based on these www.selleckchem.com/products/shp099-dihydrochloride.html guidelines, an estimated 72% of white women ages 65 and above should receive pharmacologic treatment for osteoporosis. Our findings are more consistent with the World Health Organization fracture risk assessment tool (FRAX™) guidelines which suggest that 23–46% of post-menopausal women should be treated for osteoporosis [32]. These results illustrate a potential gap in terms of clinical perception of fracture risk in a patient or benefits of therapy and treatment guidelines based on known fracture risk factors. Clinical guidelines recommend treatment in post-menopausal women with a BMD T-score of ≤−2.5 or a prior fragility fracture. Other post-menopausal women, who are candidates for treatment, are those with high

fracture risk based on a high probability of a fracture within 10 years [31]. The FRAX™ model was developed to provide a measure of fracture risk based on known fracture risk factors with or without BMD mafosfamide scores [33]. These tools help clinicians quantify risk and therefore help to target patients for treatment. BMD tests are critical in making treatment decisions. Treatment recommendations from the National Center on Clinical Excellence recommend the use of alendronate in patients with a fragility fracture only if they have a T-score ≤−2.5 [34–36]. Thus, fracture risk factors should be drivers of treatment and, therefore, should also be treatment predictors, which was largely observed in this current study. Comparison of these results to those of fracture from other studies reveals some similarities but also many gaps.