ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025
Impact of a national reimbursement policy on anti-osteoporosis medication prescription at discharge after hip-fracture surgery in Japan: an interrupted time-series analysis.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed.
- Fracture laterality as an independent prognostic factor for clinical outcomes after hip fracture surgery : an analysis of 72,008 patients.Bone & joint open · 2026Article
- Association of implementation of secondary fracture prevention incentives after hip fracture and risk of subsequent fracture in real-world practice.European geriatric medicine · 2026Article
- Impact of a national reimbursement add-on policy on refracture risk and secondary fracture prevention after hip fracture in Japan: a population-based interrupted time series analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Treatment Patterns in Hospitalized Hip Fracture Patients: An Interrupted Time-Series Analysis Around the New Fee for Secondary Fracture Prevention in Japan.Rheumatology and therapy · 2026Article
- Fracture liaison services: successful implementation in Belgium using a regional healthcare quality improvement initiative.Archives of osteoporosis · 2026Article
- Effect of PDCA cycle on critical value management in primary healthcare institutions: an interrupted time series study.Frontiers in health services · 2026Article
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Abstract
A 2022 pay-for-performance fee in Japan increased the rate of post-hip-fracture osteoporosis treatment (primarily oral agents) by 20.8 percentage points and tripled the annual uptake trend in an interrupted time-series analysis of 78,224 patients. Financial incentives embedded within national fee schedules may help close gaps in secondary fracture prevention. PURPOSE: Although osteoporosis treatment is essential for preventing secondary fractures, many patients remain untreated after hip-fracture surgery. Accordingly, Japan introduced a three-stage reimbursement add-on, the Secondary Fracture Prevention Continuous Management Fee (SFP-CMF) in April 2022. We assessed its real-world impact on anti-osteoporosis medication prescription at discharge.
methodsUsing data from Japan's Diagnosis Procedure Combination Per-Diem Payment System (DPC/PDPS) covering 172 acute-care hospitals in Aichi Prefecture, we identified a retrospective cohort of adults aged ≥ 65 years who underwent hip-fracture surgery between the first quarter of 2015 and fourth quarter of 2023. Quarterly initiation rates for any osteoporosis medication were analyzed using segmented interrupted time-series regression to estimate changes in level and slope associated with the 2022 reimbursement policy, with brief route-specific description (oral vs. injectable).
resultsWe included 78,224 patients (59,547 pre-intervention; 18,677 post-intervention). Before the policy, discharge prescription increased slowly (+ 1.4 percentage points [pp]/year; 95% CI 1.0-1.8; p < 0.001). SFP-CMF introduction was followed by an immediate + 20.8 pp change (95% CI 14.9-26.7; p < 0.001) and a + 17.8 pp/year post-intervention slope (95% CI 13.6-22.1; p < 0.001) over the subsequent 7-quarter (1.75-year) period. Most gains were attributable to oral agents (vitamin D analogs, bisphosphonates); injectables rose briefly but subsequently declined.
conclusionEmbedding a modest, stage-specific financial incentive within the national fee schedule produced a sustained large increase in anti-osteoporosis medication prescription at discharge after hip fracture, predominantly for oral agents. The concomitant decline in injectables suggests that route-specific implementation merits monitoring, and further evaluation across post-discharge phases and fracture outcomes is warranted.
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