Medical Student Stanford University School of Medicine
Introduction: Anabolic medications to treat osteoporosis reduce risk of fragility fracture, including vertebral compression fractures, compared to traditional antiresorptive medications. However, the socioeconomic differences and trends in anabolic vs. antiresorptive osteoporosis treatment have not been previously described. Our goal is to characterize the trends, socioeconomic factors, and out-of-pocket costs associated with prescription of anabolic and antiresorptive medications.
Methods: We identified all adult patients with osteoporosis from 2003-2021 in the Optum SES database (n=2,988,826). Antiresorptive (bisphosphonates, raloxifene, calcitonin, denosumab) and anabolic (teriparatide, abaloparatide, or romosozumab) osteoporosis medications were identified. Patient age, sex, race, geographical region, education level, and net worth were gathered. Primary outcomes included prescription trends and out-of-pocket cost (calculated via sum of deductible and copay), adjusted for inflation.
Results: In total, 616,635 patients received treatment (20.6%). Of this, 31,112 (5.0%) received anabolic medications. Patients treated for osteoporosis were more often female, Hispanic or Asian race, from the western US, and of higher net worth (all p< 0.0001). Patients who received anabolic agents were younger, more often male, white, higher education level and net worth (all p< 0.0001). While total anabolic medication prescriptions increased from 458 to 2,053, the proportion of patients prescribed anabolic medications remained approximately stable from 3.2% to 2.8% across the study period. Anabolic medications were most often prescribed by rheumatologists (18.5%), endocrinologists (16.8%), and internists (15.3%). Median inflation-adjusted monthly out-of-pocket costs were $17 greater for anabolic medications than antiresorptive medications ($37.60 vs. $20.27, p< 0.0001). Monthly out-of-pocket costs for anabolic medications increased from $56.69 in 2003 to $79.15 in 2021 (CAGR: 1.9%), while antiresorptive medications decreased from $28.52 in 2003 to $3.00 in 2021 (CAGR: -11.8%).
Conclusion : While the number of patients treated for osteoporosis has increased, these are disproportionately patients from higher socioeconomic status. Anabolic medications carry higher out-of-pocket cost, which has continued to increase over the recent period.
