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Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage

Authors Siris E, Yu J, Bognar K, DeKoven M, Shrestha A, Romley J, Modi A

Received 25 February 2015

Accepted for publication 23 April 2015

Published 5 November 2015 Volume 2015:10 Pages 1813—1824


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker

Ethel S Siris,1 Jingbo Yu,2 Katalin Bognar,3 Mitch DeKoven,4 Anshu Shrestha,3 John A Romley,5 Ankita Modi2

1Toni Stabile Osteoporosis Center, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, 2Merck & Co., Inc., Kenilworth, NJ, 3Precision Health Economics, Los Angeles, CA, 4Real-World Evidence Solutions, IMS Health, Fairfax, VA, 5Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA

Objectives: To examine the rate of osteoporosis (OP) undertreatment and the association between gastrointestinal (GI) events and OP treatment initiation among elderly osteoporotic women with Medicare Part D drug coverage.
Methods: This retrospective cohort study utilized a 20% random sample of Medicare beneficiaries. Included were women ≥66 years old with Medicare Part D drug coverage, newly diagnosed with OP in 2007–2008 (first diagnosis date as the index date), and with no prior OP treatment. GI event was defined as a diagnosis or procedure for a GI condition between OP diagnosis and treatment initiation or at the end of a 12-month follow-up, whichever occurred first. OP treatment initiation was defined as the use of any bisphosphonate (BIS) or non-BIS within 1 year postindex. Logistic regression, adjusted for patient characteristics, was used to model the association between 1) GI events and OP treatment initiation (treated versus nontreated); and 2) GI events and type of initial therapy (BIS versus non-BIS) among treated patients only.
Results: A total of 126,188 women met the inclusion criteria: 72.1% did not receive OP medication within 1 year of diagnosis and 27.9% had GI events. Patients with a GI event were 75.7% less likely to start OP treatment (odds ratio [OR]=0.243; P<0.001); among treated patients, patients with a GI event had 11.3% lower odds of starting with BIS versus non-BIS (OR=0.887; P<0.001).
Conclusion: Among elderly women newly diagnosed with OP, only 28% initiated OP treatment. GI events were associated with a higher likelihood of not being treated and, among treated patients, a lower likelihood of being treated with BIS versus non-BIS.

Keywords: gastrointestinal, osteoporosis, postmenopausal women, treatment initiation

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