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Osteoporosis Pharmacotherapy Use Falls Short

Osteoporosis Pharmacotherapy Use Falls Short

Pharmacotherapy use among postmenopausal women who had osteoporosis or a history of fractures was found to be suboptimal in a post hoc analysis of Women's Health Initiative clinical trials data, even though treatment guidelines are well-established.

Only 21.6% of the women reported using appropriate pharmacotherapy other than estrogen to reduce future fractures.

Researchers at the University of Florida College of Medicine, Gainesville, and other centers noted that some of the women may have had contraindications to treatment but that is unlikely to account for the majority who were not receiving treatment after the diagnosis of osteoporosis or fracture.

They presented their findings in a recent issue of The American Journal of Medicine.

The study

The researchers evaluated information from participants’ visits before and immediately after their first fracture event or osteoporosis diagnosis for medication use and used a full logistic regression model to identify factors predictive of osteoporosis medication use.

Fracture outcomes included hip, clinical spine, forearm, wrist, and total fractures that occurred after enrollment.

The researchers defined osteoporosis treatment as the use of an FDA-approved osteoporosis medication available during the study period: bisphosphonates (alendronate, ibandronate, risedronate, etidronate, and zoledronic acid), recombinant human parathyroid hormone (teriparatide), calcitonin, selective estrogen receptor modulators ([SERMs], eg, raloxifene), or any combination of the medications. Tamoxifen was included because data suggested efficacy in fracture prevention in postmenopausal women. Estrogen/hormone therapy was not included as osteoporosis treatment.

Vitamin D and calcium intake were considered as lifestyle modifications and adjuncts to pharmacotherapy. Amount of physical activity, tobacco use, and alcohol intake also were examined.

Findings

At the time of enrollment, 31% of the women reported taking estrogen, 24% took calcium supplementation, and 4% took vitamin D. Over the study period, the number of women taking bisphosphonates, calcitonin, and SERMs increased and those reporting hormone therapy use decreased.

Appropriate osteoporosis medication use was reported more frequently in visits subsequent to diagnosis of osteoporosis only (31.7%) and diagnoses of both osteoporosis and fracture (29.4%), compared with diagnosis of fracture only (5.2%), when pharmacotherapies other than hormone therapy, calcium, and vitamin D were considered.

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