Abstract
Summary
Initiation and compliance with anti-osteoporotic therapy was assessed in 152,777 fracture patients in a national population-based cohort study. Prescription rates were low, especially following hip fracture. Persistence has improved with almost 2/3 of patients who began raloxifene or weekly alendronate obtaining treatment durations equalling those of the licensing trials.
Introduction
Reducing the societal fracture burden remains challenging due to failure to treat fragility fractures and non-compliance with treatment.
Methods
We used national registers to identify patients born 1945 or earlier who sustained a fracture 1997–2004 (N = 152,777). Initiation of anti-osteoporotic therapy was defined as redemption of at least one prescription in the year following fracture. Persistence was defined as duration of time maintaining a medication possession ratio >75%.
Results
Treatment initiation within 1 year was highest after spine fracture: 39.6% of women began therapy in 2004 compared with 19.5% in 1997. In men, 16.5% began therapy in 2004 vs. 8.0% in 1997. Following hip fracture, 9.2% of women and 4.1% of men began therapy in 2004 vs. 3.4% and 0.7% in 1997, respectively. Median persistence (years) was 2.8 for daily alendronate, 3.8 for weekly alendronate, 2.5 for etidronate and 4.7 for raloxifene. The risk of discontinuing or changing therapy increased with age.
Conclusions
Prescription rates for anti-osteoporotic medication are very low, especially in hip fracture and in men. Rates were <1/3 of those reported in the US. Persistence has improved with almost 2/3 of patients who began raloxifene or weekly alendronate now obtaining treatment durations equalling those of the licensing trials.
Similar content being viewed by others
References
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882
Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18:1583–1593
Rabenda V, Mertens R, Fabri V, Vanoverloop J, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2007) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int
Gold DT, Martin BC, Frytak JR, Amonkar MM, Cosman F (2007) A claims database analysis of persistence with alendronate therapy and fracture risk in post-menopausal women with osteoporosis. Curr Med Res Opin 23:585–594
Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022
Cramer JA, Silverman SL, Gold DT (2007) Methodological considerations in using claims databases to evaluate persistence with bisphosphonates for osteoporosis. Curr Med Res Opin 23:2369–2377
Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55
Harrington JT, Broy SB, Derosa AM, Licata AA, Shewmon DA (2002) Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum 47:651–654
Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057
Port L, Center J, Briffa NK, Nguyen T, Cumming R, Eisman J (2003) Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 14:780–784
Majumdar SR, Kim N, Colman I, Chahal AM, Raymond G, Jen H, Siminoski KG, Hanley DA, Rowe BH (2005) Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Arch Intern Med 165:905–909
Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582
Morris CA, Carrino JA, Lang P, Solomon DH (2006) Incidental vertebral fractures on chest radiographs. Recognition, documentation, and treatment. J Gen Intern Med 21:352–356
Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141
Felsenberg D, Silman A, Lunt M, Armbrecht G, Ismail AA, Finn JD, Cockerill W (2002) Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724
Taylor BC, Schreiner PJ, Stone KL, Fink HA, Cummings SR, Nevitt MC, Bowman PJ, Ensrud KE (2004) Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 52:1479–1486
Kanis JA, Johnell O, Oden A, Dawson A, de Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995
Solomon DH, Brookhart MA, Gandhi TK, Karson A, Gharib S, Orav EJ, Shaykevich S, Licari A, Cabral D, Bates DW (2004) Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med 117:919–924
Cadarette SM, Katz JN, Brookhart MA, Levin R, Stedman MR, Choudhry NK, Solomon DH (2008) Trends in drug prescribing for osteoporosis after hip fracture, 1995–2004. J Rheumatol 35:319–326
Lo JC, Pressman AR, Omar MA, Ettinger B (2006) Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int 17:922–928
Solomon DH, Avorn J, Katz JN, Finkelstein JS, Arnold M, Polinski JM, Brookhart MA (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419
Cramer JA, Amonkar MM, Hebborn A, Altman R (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21:1453–1460
Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928
Papaioannou A, Ioannidis G, Adachi JD, Sebaldt RJ, Ferko N, Puglia M, Brown J, Tenenhouse A, Olszynski WP, Boulos P, Hanley DA, Josse R, Murray TM, Petrie A, Goldsmith CH (2003) Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database. Osteoporos Int 14:808–813
Beest FJ, Erkens JA, Herings RM (2008) Determinants of noncompliance with bisphosphonates in women with postmenopausal osteoporosis. Curr Med Res Opin
Gold DT, Safi W, Trinh H (2006) Patient preference and adherence: comparative US studies between two bisphosphonates, weekly risedronate and monthly ibandronate. Curr Med Res Opin 22:2383–2391
Gold DT, McClung B (2006) Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med 119:S32–S37
Hundrup YA, Hoidrup S, Obel EB, Rasmussen NK (2004) The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scand J Public Health 32:136–143
Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 46:263–268
Financial support
Kaptajnløjnant Harald Jensen og Hustrus Fond.
Conflicts of interest
Dr Abrahamsen receives consultancy fees from Nycomed and Novartis, research grants from Roche and speaker’s fees from Servier, Eli Lilly and MSD. Dr Eiken receives speaker fees from Nycomed, Roche and Servier.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roerholt, C., Eiken, P. & Abrahamsen, B. Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence. Osteoporos Int 20, 299–307 (2009). https://doi.org/10.1007/s00198-008-0651-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-008-0651-x