Substantial under-treatment among women diagnosed with osteoporosis in a US managed-care population: a retrospective analysis

Abstract

Background:

Multiple therapies are approved for the treatment of osteoporosis (OP), but many patients with osteoporosis may not initiate treatment upon osteoporosis diagnosis.

Objective:

To characterize initiation of pharmacologic OP treatment among women within 1 year of OP diagnosis in a US managed care population.

Research design and methods:

The retrospective cohort study included women aged ≥55 years with a claims-documented diagnosis of OP who were naïve to OP medications prior to OP diagnosis (index date) during 2001–2010. Continuous enrollment for 12 months before (baseline) and after (follow-up) the index date was required. Patients who received OP medications but did not have an OP diagnosis were excluded. Differences in baseline characteristics between the treated and untreated cohorts were compared using Wilcoxon rank-sum (continuous variables) and chi-square tests (categorical variables).

Main outcomes measures:

During the follow-up period, the percentages of patients treated with bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid) and non-bisphosphonates (calcitonin, raloxifene, teriparatide) were determined.

Results:

A total of 65,344 patients, mean age 65.7 years, met study inclusion exclusion criteria. During the follow-up period, 42,033 patients (64.3%) received no OP medication and 23,311 patients (35.7%) received OP treatment. A total of 20,200 patients (30.9% of total study population) received bisphosphonates and 3111 (4.8% of total) patients received non-bisphosphonates as their index medication. At baseline, untreated patients were slightly older and had higher rates of hypertension, chronic inflammatory joint disease, diabetes mellitus, and gastrointestinal events (p ≤ 0.01) compared with treated patients.

Conclusions:

Among women aged ≥55 years in a US managed-care population, 64.3% received no pharmacologic treatment within 1 year after being diagnosed with OP. The authors were not able to determine if untreated patients did not receive or did not fill a prescription. Further research is needed to understand the barriers to OP treatment and reasons for non-treatment.

Keywords::

• Under-treatment
• Bisphosphonate use
• Osteoporosis
• Post-menopausal

Transparency

Declaration of funding

This study was sponsored by Merck & Company, Inc., Whitehouse Station, NJ. Ankita Modi, Ethel Siris, and Shuvayu Sen designed the study. Jackson Tang performed the statistical analysis. Sampada Gandhi drafted the initial manuscript. All authors interpreted the results and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Declaration of financial/other relationships

Ankita Modi and Shuvayu Sen are employees of Merck & Company. Sampada Gandhi is an employee of the Rutgers School of Public Health. Ethel Siris and Jackson Tang were paid consultants to Merck in connection with this study and development of this manuscript. CMRO Peer Reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Sarah Peirce-Sandner, MS, and Laura Oberthur Johnson, PhD, are employees of Optum, Eden Prairie, MN, USA, who provided medical writing support for this manuscript that was funded by Merck & Company.

Previous presentation

Part of this work was presented at The American Society for Bone and Mineral Research (ASBMR) 2012 Annual Meeting, Minneapolis, MN, October 12–15, 2012.

Supplementary material available online Supplementary Appendix