Clinical Scorecard: Changes in the Utilization of Osteoporosis Drug Therapy Among Commercial and Medicare Advantage Patients in the U.S. from 2011 to 2022
At a Glance
Category
Detail
Condition
Osteoporosis characterized by increased bone fragility and fracture risk
Key Mechanisms
Underdiagnosis and undertreatment of osteoporosis despite availability of effective drug therapies; fragility fractures indicative of osteoporosis
Target Population
Adults aged ≥50 years with commercial or Medicare Advantage insurance, stratified by age, sex, fragility fracture, and documented osteoporosis
Care Setting
Outpatient and managed care settings within commercial and Medicare Advantage health plans in the United States
Key Highlights
Over 70% of patients with fragility fractures lacked documented osteoporosis diagnosis.
ODT fill rates increased from 2011 to 2022 among women ≥65 years with documented osteoporosis but remained low overall.
ODT use declined among women with fragility fractures but no documented osteoporosis, indicating underdiagnosis contributes to undertreatment.
Guideline-Based Recommendations
Diagnosis
Osteoporosis diagnosis based on bone density testing (T-score < -2.5) or presence of fragility fracture.
Bone density testing recommended for women aged ≥65 years and younger postmenopausal women with risk factors; less consistent for men.
Management
Use of osteoporosis drug therapies (ODTs), primarily bisphosphonates, for primary and secondary fracture prevention.
Treatment indicated for patients with documented osteoporosis and those with fragility fractures regardless of bone density.
Monitoring & Follow-up
Regular assessment of fracture risk and osteoporosis diagnosis status to guide ODT initiation and continuation.
Risks
Underdiagnosis of osteoporosis leads to underuse of ODT and increased fracture risk.
Declining bisphosphonate use noted among patients with prior fragility fractures.
Patient & Prescribing Data
Adults aged ≥50 years with commercial or Medicare Advantage insurance, stratified by age, sex, fracture history, and osteoporosis diagnosis
ODT use increased among patients with documented osteoporosis but remains low; patients with fragility fractures without documented osteoporosis have lower ODT use, highlighting underdiagnosis as a barrier.
Clinical Best Practices
Ensure osteoporosis diagnosis through bone density testing or recognition of fragility fractures.
Increase awareness that fragility fractures indicate osteoporosis warranting treatment regardless of bone density results.
Promote adherence to clinical guidelines recommending ODT for at-risk older adults to reduce fracture incidence.
Address gaps in osteoporosis documentation to improve treatment rates and fracture prevention.
by Alexander O Everhart, Juan P Brito, Bart L Clarke, Jeph Herrin, Pinar Karaca-Mandic, Kurt A Kennel, Nehu Parimi, Clifford J Rosen, Mark Takagi, Rozalina G McCoy
