Persistent Osteoporosis Medication Use Is Associated With Less Fracture Risk

The use of osteoporosis medication for 12 months reduced the risk of fractures and decreased medical costs in elderly female Medicare beneficiaries with osteoporosis, according to the results of a recent study.

Osteoporosis is a bone disease that leads to many fractures every year, particularly in the elderly population. Managing osteoporosis is extremely costly; improving management of the disease, and preventing it, is a major health goal. One of the critical obstacles that healthcare providers face is medication adherence.

Reported persistent use of oral bisphosphonates to treat osteoporosis is alarmingly low, at 45% and 30% for 12- and 24- month persistent use, respectively. Because low adherence is usually associated with poorer outcomes, there is a need to determine if higher persistence with osteoporosis medications leads to better health outcomes.

In this retrospective observational study, investigators aimed to determine whether medical persistence correlated directly with fractures risk and healthcare costs. Researchers included 294,369 Medicare-enrolled female patients. Of these patients, 32.9% took their osteoporosis medications for at least 12 months without any gaps, and the remainder were nonpersistent. The main reason for nonpersistence was usually medication discontinuation defined as a patient going at least 60 days without a refill (reported in 90.3% of patients).

For persistent patients, fracture rates were reduced in all major site-specific areas of interest, including a 31% reduction in any fracture, a 41% reduction in hip fractures, a 30% reduction in vertebral fractures, and a 17% reduction in non-hip non-vertebral fractures. When comparing adjusted fracture rate ratio of post- versus pre-initiation, investigators found persistent patients to have a ratio of 0.284, while the nonpersistent patients had an adjusted fracture rate ratio of 0.411. The difference in the groups represented a significantly greater decline in fracture rates for persistent patients compared with nonpersistent patients (P < .0001).

Total healthcare costs were also significantly lower for patients in the persistent group compared with patients who were in the nonpersistent group (P < .0001). Differences that led to the lower total costs were lower inpatient and fracture-related costs. After accounting for all cost factors, investigators determined that 12 months of persistent osteoporosis medication use led to an 8.7% reduction in total costs, representing $1379 saved per persistent patient each year.

Patients who took their osteoporosis medications with no gaps had significantly greater reduction in risk of fractures while also having significantly lower total healthcare costs. Patient adherence is a major intervention for osteoporosis and can improve outcomes and reduce costs, the researchers noted.

Reference

Liu J, Guo H, Rai P, Pinto L, Barron R. Medication persistence and risk of fracture among female Medicare beneficiaries diagnosed with osteoporosis. Osteoporos Int. 2018;29(11):2409-2917. doi: 10.1007/s00198-018-4630-6.