Medical Student Stanford University School of Medicine Woodside, California, United States
Introduction: New anabolic medications (abaloparatide and romosozumab) were recently approved for osteoporosis. Prescribing antiresorptive medications following a course of anabolic medications offers better outcomes. However, treatment guidelines remain unclear. This study aimed to characterize prescription trends, demographic differences, geographical distributions, out-of-pocket costs, and treatment sequences for anabolic and antiresorptive osteoporosis medications.
Methods: Using a commercial claims database, adult patients with osteoporosis from 2003-2021 were retrospectively reviewed. Patients were stratified based on osteoporosis medication class (antiresorptive vs. anabolic). Patient demographics and socioeconomic variables, provider types, and out-of-pocket costs were collected. Multivariable regression analyses were used to identify independent predictors of receiving treatment.
Results: 2,988,826 patients with osteoporosis were identified, 616,635 (20.6%) of whom received treatment. Patients who were female, Hispanic or Asian, from the Western U.S., have higher net worth, or greater comorbidity burden were more likely to receive medication for osteoporosis. Among patients who received medication, only 31,112 patients (5.0%) received anabolic medication, and were more often younger, White, have higher education level, net worth, and greater comorbidity burden. Providers who most commonly prescribed anabolic medications were rheumatologists (18.5%), endocrinologists (16.8%), and general internists (15.3%). From 2003-2020, osteoporosis medication prescriptions increased four-fold, while anabolic medication prescriptions did not increase at this rate. Median out-of-pocket cost was $17 higher for anabolic medications than antiresorptive medications, though costs for anabolic medications decreased significantly from 2003 to 2020 (compound annual growth rate: -0.6%). Only 8,388 (1.4%) patients tried two or more osteoporosis medications over this period, and only 0.6% followed the optimal treatment sequence.
Conclusion : Prescription of anabolic osteoporosis medications has not kept pace with overall osteoporosis treatment, and there are socioeconomic disparities in anabolic medication prescription, which may be driven by higher median out-of-pocket costs. While prescribing antiresorptive medications following a course of anabolic medications offers better outcomes, this treatment sequence occurred in only 0.6% of the study cohort.
How to Improve Patient Care: Surgeons should refer patients with poor bone quality to specialists for consideration of anabolic osteoporosis treatment.
