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Key factors included preventive-service use in the prior year, community social determinants of health (SDoH) factors derived by exploratory factor analysis, and individual demographics and comorbidities. Lasso-penalized Cox models selected essential variables and estimated adjusted hazard ratios (HRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Only 11.9% of patients were treated before fracture and 77.6% received no treatment both before and after fracture. Preventive services were associated with increased post-fracture OP treatment in both sexes (Wellness visit HR[95%CI]\u2009=\u20091.20[1.04\u20131.38] in men, 1.02[0.98\u20131.07] in women, bone mineral density testing HR\u2009=\u20091.57[1.28\u20131.94] in men,\u202f1.15[1.09\u20131.22] in women; influenza\/pneumococcal vaccination HR\u2009=\u20091.28[1.09\u20131.49] in men,\u202f1.13[1.08\u20131.19] in women). A community \u201csocioeconomic barrier\u201d factor (low income, high poverty, high mobile-home residence, uninsured) was associated with decreased post-fracture OP treatment in women (HR\u2009=\u20090.89[0.81\u20130.98]) but not in men. Antidepressant use and history of falls were associated with decreased post-fracture OP treatment in both sexes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OP treatment after fracture remains suboptimal\u2014especially among men\u2014despite clear guidelines. Engagement with preventive care was strongly associated with treatment initiation. Community socioeconomic disadvantage and depression were also important barriers to post-fracture treatment, with sex-specific patterns. Integrating fracture-care pathways into preventive visits and focusing on socioeconomically disadvantaged communities could improve secondary fracture prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-025-10090-y","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:54:49Z","timestamp":1765461289000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Individual and Community-level Determinants of Osteoporosis Treatment Following Fracture Among Medicare Beneficiaries"],"prefix":"10.1007","author":[{"given":"Hongke","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1536-706X","authenticated-orcid":false,"given":"Ye","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bisakha","family":"Sen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Curtis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"10090_CR1","doi-asserted-by":"publisher","unstructured":"Calikyan A, Silverberg J, McLeod KM. 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