Disparities in osteoporosis treatments

Ziyue Liu, J. Weaver, A. de Papp, Z. Li, J. Martin, K. Allen, Siu Hui, Erik Imel

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Summary: Osteoporosis treatment rates within 2 years following an index event (fragility fracture, osteoporotic bone mineral density (BMD) T-score, or osteoporosis ICD-9 codes) were determined from 2005 to 2011. Most patients were not treated. Fracture patients had the lowest treatment rate. Low treatment rates also occurred in patients that were male, black, or had non-commercial insurance. Introduction: Clinical recognition of osteoporosis (osteoporotic BMD, assignment of an ICD-9 code, or the occurrence of fragility fractures) provides opportunities to treat patients at risk for future fracture. Methods: A cohort of 36,965 patients was identified from 2005 to 2011 in the Indiana Health Information Exchange, with index events after age 50 of either non-traumatic fractures, an osteoporosis ICD-9 code, or a BMD T-score ≤ −2.5. Patients with osteoporosis treatment in the preceding year were excluded. Medication records during the ensuing 2 years were extracted to identify osteoporosis treatments, demographics, comorbidities, and co-medications. Predictors of treatment were evaluated in a multivariable logistic regression model. Results: The cohort was 78 % female, 11 % black, 91 % urban-dwelling, and 53 % commercially insured. The index events were as follows: osteoporosis diagnosis (47 % of patients), fragility fracture (44 %), and osteoporotic T-scores (9 %). Within 2 years after the index event, 23.3 % received osteoporosis medications (of which, 82.2 % were oral bisphosphonates). Treatment rates were higher after osteoporosis diagnosis codes (29.3 %) or osteoporotic T-score (53.9 %) than after fracture index events (10.5 %) (p < 0.001). Age had an inverted U-shaped effect for women with highest odds around 60–65 years. Women (OR 1.86) and non-black patients (OR 1.52) were more likely to be treated (p < 0.001). Patients with public (versus commercial) insurance (OR 0.86, p < 0.001) or chronic comorbidities (ORs about 0.7–0.9, p < 0.001) were less likely to be treated. Conclusion: Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.

Original languageEnglish
JournalOsteoporosis International
DOIs
StateAccepted/In press - Jul 28 2015

Fingerprint

Osteoporosis
International Classification of Diseases
Therapeutics
Bone Density
Comorbidity
Osteoporotic Fractures
Insurance
Logistic Models
Diphosphonates
Demography

Keywords

  • Bisphosphonates
  • Denosumab
  • Fracture
  • Healthcare disparities
  • Osteoporosis
  • Osteoporosis treatment
  • Raloxifene
  • Teriparatide

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Disparities in osteoporosis treatments. / Liu, Ziyue; Weaver, J.; de Papp, A.; Li, Z.; Martin, J.; Allen, K.; Hui, Siu; Imel, Erik.

In: Osteoporosis International, 28.07.2015.

Research output: Contribution to journalArticle

Liu, Ziyue ; Weaver, J. ; de Papp, A. ; Li, Z. ; Martin, J. ; Allen, K. ; Hui, Siu ; Imel, Erik. / Disparities in osteoporosis treatments. In: Osteoporosis International. 2015.
@article{3ca1ee25d0374d7983c1aa16bacab544,
title = "Disparities in osteoporosis treatments",
abstract = "Summary: Osteoporosis treatment rates within 2 years following an index event (fragility fracture, osteoporotic bone mineral density (BMD) T-score, or osteoporosis ICD-9 codes) were determined from 2005 to 2011. Most patients were not treated. Fracture patients had the lowest treatment rate. Low treatment rates also occurred in patients that were male, black, or had non-commercial insurance. Introduction: Clinical recognition of osteoporosis (osteoporotic BMD, assignment of an ICD-9 code, or the occurrence of fragility fractures) provides opportunities to treat patients at risk for future fracture. Methods: A cohort of 36,965 patients was identified from 2005 to 2011 in the Indiana Health Information Exchange, with index events after age 50 of either non-traumatic fractures, an osteoporosis ICD-9 code, or a BMD T-score ≤ −2.5. Patients with osteoporosis treatment in the preceding year were excluded. Medication records during the ensuing 2 years were extracted to identify osteoporosis treatments, demographics, comorbidities, and co-medications. Predictors of treatment were evaluated in a multivariable logistic regression model. Results: The cohort was 78 {\%} female, 11 {\%} black, 91 {\%} urban-dwelling, and 53 {\%} commercially insured. The index events were as follows: osteoporosis diagnosis (47 {\%} of patients), fragility fracture (44 {\%}), and osteoporotic T-scores (9 {\%}). Within 2 years after the index event, 23.3 {\%} received osteoporosis medications (of which, 82.2 {\%} were oral bisphosphonates). Treatment rates were higher after osteoporosis diagnosis codes (29.3 {\%}) or osteoporotic T-score (53.9 {\%}) than after fracture index events (10.5 {\%}) (p < 0.001). Age had an inverted U-shaped effect for women with highest odds around 60–65 years. Women (OR 1.86) and non-black patients (OR 1.52) were more likely to be treated (p < 0.001). Patients with public (versus commercial) insurance (OR 0.86, p < 0.001) or chronic comorbidities (ORs about 0.7–0.9, p < 0.001) were less likely to be treated. Conclusion: Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.",
keywords = "Bisphosphonates, Denosumab, Fracture, Healthcare disparities, Osteoporosis, Osteoporosis treatment, Raloxifene, Teriparatide",
author = "Ziyue Liu and J. Weaver and {de Papp}, A. and Z. Li and J. Martin and K. Allen and Siu Hui and Erik Imel",
year = "2015",
month = "7",
day = "28",
doi = "10.1007/s00198-015-3249-0",
language = "English",
journal = "Osteoporosis International",
issn = "0937-941X",
publisher = "Springer London",

}

TY - JOUR

T1 - Disparities in osteoporosis treatments

AU - Liu, Ziyue

AU - Weaver, J.

AU - de Papp, A.

AU - Li, Z.

AU - Martin, J.

AU - Allen, K.

AU - Hui, Siu

AU - Imel, Erik

PY - 2015/7/28

Y1 - 2015/7/28

N2 - Summary: Osteoporosis treatment rates within 2 years following an index event (fragility fracture, osteoporotic bone mineral density (BMD) T-score, or osteoporosis ICD-9 codes) were determined from 2005 to 2011. Most patients were not treated. Fracture patients had the lowest treatment rate. Low treatment rates also occurred in patients that were male, black, or had non-commercial insurance. Introduction: Clinical recognition of osteoporosis (osteoporotic BMD, assignment of an ICD-9 code, or the occurrence of fragility fractures) provides opportunities to treat patients at risk for future fracture. Methods: A cohort of 36,965 patients was identified from 2005 to 2011 in the Indiana Health Information Exchange, with index events after age 50 of either non-traumatic fractures, an osteoporosis ICD-9 code, or a BMD T-score ≤ −2.5. Patients with osteoporosis treatment in the preceding year were excluded. Medication records during the ensuing 2 years were extracted to identify osteoporosis treatments, demographics, comorbidities, and co-medications. Predictors of treatment were evaluated in a multivariable logistic regression model. Results: The cohort was 78 % female, 11 % black, 91 % urban-dwelling, and 53 % commercially insured. The index events were as follows: osteoporosis diagnosis (47 % of patients), fragility fracture (44 %), and osteoporotic T-scores (9 %). Within 2 years after the index event, 23.3 % received osteoporosis medications (of which, 82.2 % were oral bisphosphonates). Treatment rates were higher after osteoporosis diagnosis codes (29.3 %) or osteoporotic T-score (53.9 %) than after fracture index events (10.5 %) (p < 0.001). Age had an inverted U-shaped effect for women with highest odds around 60–65 years. Women (OR 1.86) and non-black patients (OR 1.52) were more likely to be treated (p < 0.001). Patients with public (versus commercial) insurance (OR 0.86, p < 0.001) or chronic comorbidities (ORs about 0.7–0.9, p < 0.001) were less likely to be treated. Conclusion: Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.

AB - Summary: Osteoporosis treatment rates within 2 years following an index event (fragility fracture, osteoporotic bone mineral density (BMD) T-score, or osteoporosis ICD-9 codes) were determined from 2005 to 2011. Most patients were not treated. Fracture patients had the lowest treatment rate. Low treatment rates also occurred in patients that were male, black, or had non-commercial insurance. Introduction: Clinical recognition of osteoporosis (osteoporotic BMD, assignment of an ICD-9 code, or the occurrence of fragility fractures) provides opportunities to treat patients at risk for future fracture. Methods: A cohort of 36,965 patients was identified from 2005 to 2011 in the Indiana Health Information Exchange, with index events after age 50 of either non-traumatic fractures, an osteoporosis ICD-9 code, or a BMD T-score ≤ −2.5. Patients with osteoporosis treatment in the preceding year were excluded. Medication records during the ensuing 2 years were extracted to identify osteoporosis treatments, demographics, comorbidities, and co-medications. Predictors of treatment were evaluated in a multivariable logistic regression model. Results: The cohort was 78 % female, 11 % black, 91 % urban-dwelling, and 53 % commercially insured. The index events were as follows: osteoporosis diagnosis (47 % of patients), fragility fracture (44 %), and osteoporotic T-scores (9 %). Within 2 years after the index event, 23.3 % received osteoporosis medications (of which, 82.2 % were oral bisphosphonates). Treatment rates were higher after osteoporosis diagnosis codes (29.3 %) or osteoporotic T-score (53.9 %) than after fracture index events (10.5 %) (p < 0.001). Age had an inverted U-shaped effect for women with highest odds around 60–65 years. Women (OR 1.86) and non-black patients (OR 1.52) were more likely to be treated (p < 0.001). Patients with public (versus commercial) insurance (OR 0.86, p < 0.001) or chronic comorbidities (ORs about 0.7–0.9, p < 0.001) were less likely to be treated. Conclusion: Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.

KW - Bisphosphonates

KW - Denosumab

KW - Fracture

KW - Healthcare disparities

KW - Osteoporosis

KW - Osteoporosis treatment

KW - Raloxifene

KW - Teriparatide

UR - http://www.scopus.com/inward/record.url?scp=84937942126&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937942126&partnerID=8YFLogxK

U2 - 10.1007/s00198-015-3249-0

DO - 10.1007/s00198-015-3249-0

M3 - Article

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

ER -