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] = 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 = 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.

Keywords:

• Fracture
• Medicare
• Osteoporosis
• Undertreatment

Transparency

Declaration of funding

This study was supported by Merck & Co. Inc.

Declaration of financial/other relationships

X.Y. and A.M. have disclosed that they are employees of Merck & Co. Inc. S.S. has disclosed that he was an employee of Merck & Co. Inc. at the time this study was conducted.

CMRO peer reviewer 1 has disclosed that she has received grants from Amgen; peer reviewer 2 has no relevant financial or other relationships to disclose.

Acknowledgments

Craig Solid PhD (Solid Research Group LLC, St Paul, MN, USA) and Sarah Peirce-Sandner MS (Optum, Eden Prairie, MN, USA) provided medical writing support with funding by Merck & Co. Inc.

Previous presentation: Portions of these results were presented at the 2015 Interdisciplinary Symposium on Osteoporosis in Washington, DC, USA, 21 May 2015.