What stops people in Thailand from accessing osteoporosis medication?

In Thailand, healthcare professionals do not initiate osteoporosis treatment for half the people who have experienced a hip fracture with the main factors being male, having a high comorbidity level, and having an education level at the secondary school level or below

Anti-osteoporosis medications are important to prevent fragility fractures, especially for those patients who previously had one. Surprisingly, the anti-osteoporosis treatment rate is low, globally. Understanding why patients do not receive medication is crucial to improving the overall rate of osteoporosis treatment. Multiple factors are affecting these rates and might be different per institution and country. 

A study by Maihasavariya et al. (published Feb 2023) explored the osteoporosis treatment gaps in Siriraj Hospital, Mahidol University, a tertiary university medical center in Thailand. Using Siriraj’s FLS registry data from 2016 to 2019, they found out that the chief predictors for not receiving medication are 1) being male 2) high comorbidity level 3) education level (secondary school or below). Of all the patients eligible for this study, almost half did not receive anti-osteoporosis medication 1 year after hip fracture treatment because healthcare providers neither discussed nor initiated pharmacological treatment for osteoporosis. Financial constraints, patient perception against anti-osteoporosis medication, concerns about adverse medication effects, and inappropriate medical conditions, make up half of the reasons why they did not receive medication after 1 year. It was also found in the study that when medication was prescribed, non-persistence primarily stemmed from transportation difficulties that resulted in patients missing follow-ups.

The authors said in the paper, "this finding underscores attitudes toward anti-osteoporosis medications might improve the rate of treatment” and that, “developing a follow-up team and facilitating access to medications (e.g., courier delivery to patients) would help to decrease the number of patients who discontinue anti-osteoporosis treatment.” Preventing a second fracture is a critical strategy to improve the lives of people in Thailand.

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