Predicting osteoporosis medication receipt in Veterans with a spinal cord injury: A retrospective cohort study

Abstract

Objective: To describe frequency and predictors of use of pharmacological therapies for osteoporosis in persons with a spinal cord injury (SCI).

Design: Retrospective cohort study.

Setting: United States Veterans Health Administration (VA) national databases.

Participants: 11,048 persons with a traumatic SCI who received VA health care between Fiscal Years (FY) 2005–2015. Pharmacy data from VA’s Corporate Data Warehouse were used to identify prescriptions for Food and Drug Administration-approved pharmacological treatments for osteoporosis including bisphosphonates, calcitonin, denosumab, raloxifene and teriparatide.

Outcome Measures: Demographics, clinical and SCI-related characteristics, receipt of a dual energy x-ray absorptiometry (DXA), and prevalent lower extremity fractures were examined to determine factors related to receiving a pharmacological agent for osteoporosis.

Results: 1,041 persons (9.4%) had a prescription for a pharmacological agent for osteoporosis; the majority (n = 964, 93.0%) were bisphosphonates. There was a significant decline in the number of these prescriptions from FY 2005 (13.0%) to FY 2015 (2.2%). In multivariable analysis, age (>50 years) (OR = 1.60, 95% CI 1.31–1.94); female sex (OR = 4.09, 95% CI 2.74–6.09); opioid (OR = 1.24, 95% CI 1.01–1.51) or corticosteroid (OR = 1.92, 95% CI 1.01–1.51) prescriptions; complete injury (OR = 1.26, 95% CI 1.04–1.53); receipt of a DXA scan (OR = 84.03, 95% CI 59.80–118.07) and prevalent fracture (OR = 5.43, 95% CI 4.13–7.15) were positive predictors. Black race (OR = 0.43, 95% CI 0.33–0.57) and obese BMI (OR = 0.59, 95% CI 0.45–0.76) were negative predictors.

Conclusions: Prescriptions for osteoporosis medications for persons with a SCI declined in recent years. The strongest predictors for having filled these prescriptions were having had a DXA or a prevalent fracture.

Keywords:

• Spinal cord injury
• Osteoporosis

Acknowledgements

The contents of this work do not represent the views of the Department of Veterans Affairs or the United States Government.

Disclaimer statements

Contributors FMW, BL, CR, LC were responsible for writing the protocol and report, conducting the research and drafting the manuscript. SM and BG conducted the data analysis and drafted the statistical analysis section of the manuscript. All authors gave final approval for the manuscript.

Funding This work was funded by the U.S. Department of Defense (DOD) [grant number #SC150092].

Conflicts of interest None.

ORCID

Cara Ray http://orcid.org/0000-0002-1383-8801

Laura D. Carbone http://orcid.org/0000-0003-3370-4680