High rate of non-treatment among osteoporotic women enrolled in a US Medicare plan

Abstract

Objective: To estimate the rate of non-treatment among elderly women with osteoporosis (OP) and to examine the association between patient characteristics and receiving treatment. Research design and methods: This cross-sectional, retrospective, observational study utilized patient information and claims from the Humana database to identify Medicare covered women aged 65 years old and continuously enrolled with evidence of either an OP diagnosis or an OP-related fracture during 2007-2011. The main outcome was receipt of pharmacological treatment of OP during 2012 (follow-up). The percentage of non-treatment was calculated and a stepwise selection logistic regression model was employed to estimate the association between baseline demographic and clinical characteristics and receiving treatment. Results: A total of 109,829 patients were included. Mean age was 75.7 years and 79.4% were identified with OP through OP diagnosis codes and did not have evidence of a prior fracture. Approximately one-third (32%) of patients had used OP medications during the baseline period, and 39% had experienced at least one gastro-intestinal event during baseline. Among all patients, 71.4% did not receive OP therapy during follow-up. The strongest factor associated with receiving treatment was prior use of OP therapy (odds ratio [OR] ¼ 31.3; p < .001). Among the subgroup of patients with baseline fractures, 75.9% did not receive OP therapy during follow-up and the strongest factor associated with receiving treatment remained prior use of OP therapy (OR ¼ 20.4; p < .001). Those with high comorbidity burden were less likely to receive treatment in both the overall cohort and within the subgroup with baseline fractures. Conclusions: Among Medicare-eligible women aged 65 identified with OP between 2007 and 2011, 71.4% did not receive OP treatment during 2012, including 75.9% of the subgroup of patients with a prior fracture. The use of diagnosis and procedures codes to identify patients with osteoporosis is subject to variation in coding.ARTICLE HISTORY

Extensive undertreatment of osteoporosis in older Swedish women

“…Previously performed studies in Europe and in the US have been based on register data for prevalence of osteoporosis and osteoporosis medication [ 10 , 11 , 31 ], and were therefore not able to fully take all relevant clinical risk factors into account. Being able to take most relevant clinical risk factors into account, we found in the present study that the treatment gap, according to NOF guidelines, in our older Swedish women was similar or somewhat lower than what was previously reported in older women in the US [ 19 , 20 ].…”

“…Relevant criteria include the presence of osteoporosis at one or more densitometric site, prior fracture (particularly spine, hip, or multiple fractures), and high fracture probabilities. Irrespective of the criteria used, the uptake of bone-specific treatment is low [ 10 , 11 ]. A large Danish register study found that only a small fraction of the expected number of women with osteoporosis were diagnosed and that very few women with fractures received osteoporosis medication after age 50 years [ 10 , 11 ].…”

“…Irrespective of the criteria used, the uptake of bone-specific treatment is low [ 10 , 11 ]. A large Danish register study found that only a small fraction of the expected number of women with osteoporosis were diagnosed and that very few women with fractures received osteoporosis medication after age 50 years [ 10 , 11 ]. Studies from Germany and the US have shown that only 21.7% and 28.6% of patients with diagnosed osteoporosis received an osteoporosis medication, respectively [ 10 , 11 ].…”

The role of carboxy-terminal cross-linking telopeptide of type I collagen, dual x-ray absorptiometry bone strain and Romberg test in a new osteoporotic fracture risk evaluation: A proposal from an observational study

“…These criticisms have raised a hot debate[ 26 – 31 ], and most of the cited arguments have been countered on the basis of the existing literature, without reaching a definitive clarification of the question.…”

Determinants of imminent fracture risk in postmenopausal women with osteoporosis

“…Suboptimal treatment is an issue even among women with a history of osteoporotic fracture, whose risk is particularly elevated for another fracture. As few as one of every four Medicare patients in the USA received treatment after fracture [7,8].…”