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Osteoporosis drug initiation rate continues to decline, raising fracture risk
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The rate of osteoporosis medication initiation for older adults hospitalized for hip fracture has fallen steadily during the past decade, according to an insurance claims database analysis published in JAMA Network Open.
“Recurrent fractures after an initial osteoporotic fracture is a major public health burden, as 15% to 25% of patients experience a second fracture within 10 years,” Rishi J. Desai, MD, PhD, of the division of pharmacoepidemiology and pharmacoeconomics, department of medicine, Brigham and Women’s Hospital, and colleagues wrote in the study background. “Therefore, treatment with osteoporosis medication is recommended in patients with hip fracture to prevent subsequent fractures. However, treatment rates in this population are reported to be low and decreasing over time, with recent studies suggesting rates of any treatment use after hip fracture in the range of 13% to 21% in the United States in 2012.”
Desai and colleagues analyzed data from 97,169 patients aged at least 50 years not taking an osteoporosis medication when hospitalized with a hip fracture, enrolled in a commercial health insurance plan for at least 6 months before hospital entry date (66% women; mean age, 80 years), using data from Truven MarketScan commercial claims between 2004 and September 2015. Researchers identified a period of 180 days after hip fracture hospitalization to assess newly filled prescriptions for osteoporosis treatment, such as bisphosphonates, teriparatide (Forteo, Eli Lilly) or denosumab (Prolia, Amgen), and rates of initiation were described over calendar time. Primary outcome was time-to-event of composite nonvertebral osteoporotic fracture, including humerus, radius, ulna, hip or pelvis. Follow-up began on the day after study index data and continued until change in exposure status (initiation of osteoporosis medication for nonuser patients and discontinuation of medication for using patients, defined as no new prescription filled for 90 days), in-hospital mortality or end of enrollment.
Within the cohort, 6,743 patients (6.9%) initiated osteoporosis treatment within 180 days of their hip fracture. Researchers observed a continuous decline in osteoporosis medication initiation rates in patients with hip fracture, falling from 9.8% in 2004 to 3.3% in 2015.
Researchers observed 203 nonvertebral fractures among patients who initiated osteoporosis treatment during 3,798 person-years of follow-up vs. 1,737 events observed among nonusers during 26,688 person-years of follow-up. Of 1,940 total events, hip and pelvis fractures were most frequent, according to the researchers, accounting for 39.1% and 39.7% of events, respectively. Incidence rates for fracture for osteoporosis medication initiators vs. nonusers were 5.34 (95% CI, 4.63-6.13) vs. 6.5 (95% CI, 6.21-6.82) per 100 person-years.
In instrumental variable analysis with hospital preference, researchers observed a rate difference of 4.2 events (95% CI, 1.1-7.3) per 100 person-years in subsequent fractures associated with osteoporosis treatment initiation vs. nonuse.
The researchers noted that patients in this cohort are somewhat younger and had fewer comorbid complications vs. fee-for-service Medicare cohorts described in similar studies, and the magnitude of effects may not extend to traditional Medicare patients.
“Improving prescriber adherence to prescribing guidelines and patient adherence to prescribed regimen may result in notable public health benefit,” the researchers wrote. – by Regina Schaffer
Disclosures: Merck funded this research. Brigham and Women’s Hospital retained the right to publish any results without approval from Merck. Desai reports he received grants from Merck during the study. Please see the study for the other authors’ relevant financial disclosures.
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