Abstract
This study aimed to evaluate the differences of prescribing pattern between bisphosphonate and raloxifene users among Korean women with osteoporosis, focusing on the underlying conditions, concurrent medications, nature of healthcare utilization, and regional disparity. We used the Health Insurance Review and Assessment Service National Patients Sample database of the year 2010. Study subjects were defined as female osteoporosis patients aged over 50 years with both the diagnosis of osteoporosis and prescriptions of bisphosphonate or raloxifene. The frequency and the proportion of bisphosphonate and raloxifene were compared using chi-square test and the trend of the proportion using the Cochran–Armitage test. Medications were quantified as defined daily doses per 1,000 patients per day. The prescription pattern was visualized by using the Quantum Geographic Information Systems program. Of the 1,367,367 people who utilized medical services in 2010, the final number of study subjects was 26,881—26,032 (96.8%) bisphosphonate and 849 (3.2%) raloxifene recipients. Raloxifene users were younger than bisphosphonate users and were more frequently patients with a lipid disorder (16.0% vs. 22.1%, p-value < 0.0001), rheumatic disease (4.0% vs. 6.1%, p-value = 0.0024), hot flash (1.8% vs. 6.1%, p <0.0001), and coronary artery disease (1.2% vs. 2.8%, p< 0.0001). The proportion of raloxifene users was higher in tertiary care institutions (21.6% vs. 44.7%, p-value < 0.0001). A regional distribution showed that raloxifene use was higher in the Seoul metropolitan area. These differences in demographic and clinical profiles of each recipient may influence prescription decisions.
Highlights
Osteoporosis is a serious public health problem, in postmenopausal women
In Korea, the prevalence of osteoporosis has been reported to be 33.3% among females aged over 50 years in the national health insurance claims data for 2005 and 2008 [1], and 35.5% in the data for 2008 and 2009, as obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) [2]
The data underlying the present study is freely available upon request from the authors, and the raw data can be purchased from the Health Insurance Review and Assessment Service of Korea
Summary
Osteoporosis is a serious public health problem, in postmenopausal women. In Korea, the prevalence of osteoporosis has been reported to be 33.3% among females aged over 50 years in the national health insurance claims data for 2005 and 2008 [1], and 35.5% in the data for 2008 and 2009, as obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) [2]. One in three women in Korea is likely to have weakened bones with an increased risk of fractures. The prevalence of osteoporosis in elderly women in Korea is expected to rise, while currently, Korea is categorized as a country with a medium risk of hip fracture as compared to 62 other countries [3]. Bisphosphonate and raloxifene are the osteoporosis medications most commonly prescribed by clinicians. While bisphosphonate decreased the fracture incidence more in most of the studies, raloxifene had beneficial effects on lipid metabolism and breast cancer [5,11]. The most appropriate selection of osteoporosis treatment for individual patients remains controversial; the different efficacy and safety features of the two medications should be considered to optimize the treatment of osteoporosis patients
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