Medication initiation rates are not directly comparable across secondary fracture prevention programs: reporting standards based on a systematic review.

To examine the methods used to calculate the reported medication initiation rates in secondary fracture prevention programs.A systematic review was conducted on postfracture interventions that aimed to improve osteoporosis management in an orthopedic environment. Two authors independently reviewed eligible articles to determine the numerator and denominator used to calculate the rates of antiresorptive medication initiation based on author reports. In interventions with numerator and denominator combinations that appeared to be comparable, we examined the inclusion and exclusion criteria to confirm comparability.Fifty-seven articles reporting on 64 interventions were eligible for the review. A total of 28 different combinations of numerators and denominators to calculate rates were reported for medication initiation across 49 of the 64 interventions. After examining the inclusion and exclusion criteria for rates that appeared to be comparable, the highest number of interventions with a comparable rate was 3.Reporting processes for antiresorptive medication initiation outcomes in secondary fracture prevention programs used heterogeneous standards that prevented useful comparison of programs. Applying different numerator and denominator combinations meant that the same observed number of patients could have resulted in different reported rates. We propose standards for reporting medication initiation rates in such programs.