Trends in Osteoporosis Drug Therapy Use Among US Commercial and Medicare Patients, 2011-2022

Overview

This retrospective analysis of over 166 million patient-quarter observations from 2011 to 2022 found that osteoporosis drug therapy (ODT) use increased among patients with documented osteoporosis but remained low overall. Notably, more than 70% of patients with fragility fractures lacked a documented osteoporosis diagnosis, correlating with low ODT use in this group.

Background

Osteoporosis significantly increases fracture risk, affecting approximately 40% of women and 20% of men during their lifetime, leading to substantial morbidity, mortality, and healthcare costs. Despite effective drug therapies to prevent fractures, osteoporosis remains underdiagnosed and undertreated. Diagnosis is based on bone density testing or occurrence of fragility fractures, with guidelines recommending treatment for both primary and secondary prevention. Prior studies have shown declining bisphosphonate use among fracture patients, highlighting a need to understand broader treatment patterns.

Data Highlights

Key Findings

• Over 70% of patients with fragility fractures did not have a documented osteoporosis diagnosis.
• ODT fill rates increased significantly from 2011 to 2022 among women aged ≥65 years with documented osteoporosis, both with and without fragility fractures.
• ODT use declined among women with fragility fractures but no documented osteoporosis, indicating potential underdiagnosis.
• Similar trends in ODT use were observed among women aged 50-64 years and men.
• Despite increases, ODT use remains low overall, especially in patients with fragility fractures lacking osteoporosis diagnosis.

Clinical Implications

These findings highlight the critical gap in osteoporosis diagnosis, particularly among patients presenting with fragility fractures who are not recognized as having osteoporosis. Clinicians should be vigilant in diagnosing osteoporosis in fracture patients to ensure appropriate initiation of drug therapy. Improving diagnosis rates may enhance secondary prevention and reduce fracture-related morbidity.

Conclusion

While ODT use has increased among patients with documented osteoporosis, underdiagnosis remains a major barrier to optimal treatment, especially in those with fragility fractures. Addressing this gap is essential to improve osteoporosis management and fracture prevention.

References

1. Cromer and D’Silva et al. 2020 -- Trends in Osteoporosis Drug Use After Fracture
2. Wadhwa et al. 2022 -- Osteoporosis Diagnosis and Treatment Patterns
3. OptumLabs Data Warehouse -- Data Source for Analysis