Predictors of oral bisphosphonate prescriptions in post-menopausal women with osteoporosis in a real-world setting in the USA

Asche, Carl V.; Nelson, Richard E.; McAdam‐Marx, Carrie; Jhaveri, Manan; Ye, Xiangyang

doi:10.1007/s00198-009-1079-7

Cited by 25 publications

(29 citation statements)

References 34 publications

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“…Hamel et al reported that a finding of osteoporosis or osteopenia by first BMD testing influenced the prescribing of bisphosphonates, while a pretest history of fracture did not[15]. Asche et al also examined predictors of oral bisphosphonate prescriptions in postmenopausal women, and found that fracture history, older age, low T-score (≤–2.5), and oral corticosteroid use were associated with treatment with an oral bisphosphonate [16]. Onder et al studied patients with a diagnosis of osteoporosis who were discharged from hospital [17].…”

Section: Discussionmentioning

confidence: 99%

Characteristics associated with anti-osteoporosis medication use: Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) USA cohort

Guggina¹,

Flahive²,

Hooven³

et al. 2012

Bone

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Introduction Many women at risk of fracture do not receive anti-osteoporosis medication (AOM), while others may be receiving unnecessary treatment. Purpose To examine the characteristics associated with AOM use among women at low and high risk of fracture. Methods The Global Longitudinal Study of Osteoporosis in Women (GLOW) is a prospective cohort study in which data were collected, via self-administered questionnaires, from 60,393 non-institutionalized women aged ≥55 years in 10 countries between October 1, 2006 and April 30, 2008. This is a cross-sectional analysis of baseline USA data, in which women were classified as having low fracture risk (<65 years; no FRAX risk factors) or high fracture risk (≥65 years; prior fracture or ≥2 other FRAX risk factors). Results Of 27,957 women, 3013 were at low risk of fracture and 3699 were at high risk. Only 35.7% of high-risk women reported AOM treatment, rising to 39.5% for those with self-reported osteopenia and 65.4% for those with self-reported osteoporosis. Conversely, 13.4% of low-risk women reported AOM, rising to 28.7% for osteopenia and 62.4% for osteoporosis. Characteristics associated with significantly higher AOM treatment rates among low-and high-risk women were: osteoporosis (odds ratios 75.3 and 18.1, respectively), osteopenia (17.9 and 6.3), concern about osteoporosis (2.0 and 1.8), higher perceived risk of fracture (2.3 and 1.6), and higher vitality score (1.7 and 1.6). Conclusion Use of AOM is frequently inconsistent with published guidelines in both high -and low-risk women. Characteristics other than FRAX fracture risk appear to influence this use, particularly the presence of self-reported osteoporosis.

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Section: Discussionmentioning

confidence: 99%

Characteristics associated with anti-osteoporosis medication use: Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) USA cohort

Guggina¹,

Flahive²,

Hooven³

et al. 2012

Bone

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“…Results from multiple studies suggest that the methods used to identify OP and treatment for OP may influence the level of treatment penetration observed. In a study of self-reported OP patients, 54.9% reported receiving treatment 33 , while a study that compared treatment rates by the method of OP identification observed that 9.4% of patients identified through the occurrence of a fracture received treatment within 90 days, while among patients identified via ICD-9-CM diagnosis or the presence of a bone-mineral density test, the percentage treated within 90 days was 41.6% 28 .…”

Section: Discussionmentioning

confidence: 99%

“…In some studies, older patients were less likely to receive OP treatment 16,20 , although BP treatment appears to be more likely as age increases 20,28 . Other factors that have been reported to have a positive association with receiving OP treatment include lower body mass index 28,33 and lower disease burden 33 , including lower incidence of chronic inflammatory joint disease, hypertension, and diabetes 20 . These studies parallel our results which suggest that patients with higher disease burden, comorbid hypertension and diabetes, and patients who were obese were less likely to receive OP treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, this study sought to estimate the proportion of non-treatment among Medicare-covered individuals diagnosed with OP or having at least one OP-related fracture and to examine patient characteristics associated with receiving treatment. We also assessed outcomes among the subset of patients with a history of OP-related fracture, as previous research has reported substantially different treatment rates between those with and without a previous fracture 28 .…”

Section: Introductionmentioning

confidence: 99%

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

Yang

Sajjan

Modi

2016

Current Medical Research and Opinion

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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

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“…In Denmark an increasing trend of alendronate treatment in patients with systemic GC exposure was found, indicating increased awareness of GIOP [106]. However, in another study on postmenopausal women with osteoporosis, many patients were untreated [107]; similarly, bone health-related care was found suboptimal in specific patients groups [108], such as a community-based cohort of SLE patients [109], and RA patients using GCs [110]. On average, approximately 27-40% of those who should receive a prescription for bone protective drugs receive one [111,112].…”

Section: Stage 0: Awareness Agreement and Infrastructurementioning

confidence: 99%

Glucocorticoid-induced osteoporosis: an overview

Kuchuk¹,

Hoes²,

Bijlsma³

et al. 2014

International Journal of Clinical Rheumatology

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Glucocorticoid-induced osteoporosis: an overviewGlucocorticoid-induced osteoporosis (GIOP) is one of the most serious adverse effects of glucocorticoids. Despite guidelines on the management of GIOP, effective medications and fracture outpatient clinics, this condition remains under-recognized and under-treated. This review covers recent insights into mechanisms involved in GIOP, monitoring for adverse effects of glucocorticoids on bone and prevention and treatment of GIOP. Recent guidelines on GIOP are discussed and a research agenda is proposed. EpidemiologyDespite development of many immunosuppressive nonbiological and biological drugs, glucocorticoids (GCs) still are widely used in the treatment of chronic allergic, inflammatory and autoimmune diseases and vasculitides, for their antiallergic, anti-inflammatory and immunosuppressive effects. A study showed that in the UK oral GCs were used by 0.9% of the adult population, with the highest use (2.5%) among elderly of 70-79 years of age; the most frequent indications overall for long-term GC treatment were respiratory diseases (40%) and arthropathies (19%) [1]. A recent study estimated that the prevalence of GC use, mostly of a long duration, in the USA is 1.2%, with infrequent use of a concomitant bisphosphonate [2].Since their introduction in the 1950s by Hench and collaborators [3], adverse effects are recognized, but their management and prevention still are very actual issues nowadays, approximately 60 years later [4,5]. Of these adverse effects, glucocorticoid-induced osteoporosis (GIOP) is a frequent and potentially disabling condition. In a meta-analysis on oral GC therapy and loss of bone mineral density (BMD) or fracture risk, including 66 papers on bone density and 23 on fractures, the risk of fracture was found to increase rapidly already within 3-6 months after the start of oral GC therapy more than 5 mg prednisone-equivalent per day, independently of disease treated, age and gender [6]. In that study, strong correlations were observed between cumulative dose of GCs and loss of BMD and between daily dose of GCs and risk of fracture. In another study, the combined effect of higher daily dose (>10 mg per day), longer duration of therapy (≥90 days of use) and continuous GC intake was associated with a relative risk for hip fracture of 7.16 (95% CI: 2.13-24.0) and for vertebral fracture of 16.94 (95% CI: 8.17-35.11) [7]. These data indicate a rapid deleterious effect, especially on trabecular bone, in line with the clinical observation that the prevalence of vertebral fractures during GC treatment is higher than that of other common sites for osteoporotic fracture, such as femur, humerus, forearm and wrist, ribs and other nonvertebral sites [8]. Nonvertebral fractures, especially of the femur, cause acute pain and loss of function, and nearly always lead to hospitalization, with serious mortality and morbidity, for example, slow recovery and often incomplete rehabilitation, leading to decreased physical and social functioning For reprint orders, please...

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Predictors of oral bisphosphonate prescriptions in post-menopausal women with osteoporosis in a real-world setting in the USA

Cited by 25 publications

References 34 publications

Characteristics associated with anti-osteoporosis medication use: Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) USA cohort

Characteristics associated with anti-osteoporosis medication use: Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) USA cohort

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

Glucocorticoid-induced osteoporosis: an overview

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