Patterns of Anti-Osteoporosis Medication Use among Women at High Risk of Fracture: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)

Stephen Gehlbach,Frederick A Anderson,Allison Wyman,Andrew G Bushmakin,Jonathan D Adachi,Frederick H Hooven,Xuemei Luo,Adolfo Diez-Perez,For The Glow Investigators

doi:10.1371/journal.pone.0082840

Abstract

ObjectiveTo assess patterns of anti-osteoporosis medication (AOM) use over 3 years among women at high risk of major fracture.MethodsThe GLOW registry follows a cohort of more than 40,000 women aged ≥55 from 615 primary care practices in 10 countries. Self-administered surveys (baseline, 12, 24, and 36 months) collected data on patient characteristics, perception of fracture risk, and AOM use. FRAX scores were calculated from the baseline surveys and women classified as high risk if their FRAX 10-year probability of major fracture was ≥20%.ResultsA total of 5774 women were classified as at high risk and had complete data over 3 years. At baseline, 2271 (39%) reported receiving AOM, 739 (13%) reported prior but not current use, and 2764 (48%) said they had never used AOM. Over 3 years, 85% of baseline non-users continued as non-users and 15% initiated AOM; among baseline users, 49% continued the same medication class, 29% stopped AOM, and 12% switched. Women who stopped AOM were less likely to self-report osteoporosis (HR 0.56, 95% CI 0.42–0.75) than women who continued AOM. Compared with non-users who did not begin treatment, women initiating AOM were more likely to report a diagnosis of osteoporosis (HR 11.3, 95% CI 8.2–15.5) or osteopenia (HR 4.1, 95% CI 2.9–5.7) and be very concerned about osteoporosis (HR 1.9, 95% CI 1.3–2.8).ConclusionsLess than 40% of women at high risk of fracture reported taking AOM. Women who stopped AOM were less likely to believe they have osteoporosis. Women who initiated treatment appeared motivated primarily by a diagnosis of osteoporosis or osteopenia and concern about the condition.

Highlights

Anti-osteoporosis medications (AOMs) are efficacious in reducing risk of fractures in postmenopausal women [1,2,3]
We selected postmenopausal women at high risk of major fracture, as determined by the World Health Organization FRAX tool [10,11], to describe patterns of AOM use during 3 years of observation and to identify characteristics associated with these patterns
International cohort of high-risk postmenopausal women, we looked for characteristics that could help explain patterns of medication use

Summary

Introduction

Anti-osteoporosis medications (AOMs) are efficacious in reducing risk of fractures in postmenopausal women [1,2,3]. Effective fracture prevention has been hampered by suboptimal prescribing of medications to high-risk women [4,5,6] and low adherence among women who have started AOM [7,8,9]. Identifying factors associated with patterns of use of these medications has the potential to improve prescribing and adherence. We selected postmenopausal women at high risk of major fracture, as determined by the World Health Organization FRAX tool [10,11], to describe patterns of AOM use during 3 years of observation and to identify characteristics associated with these patterns

Methods

Results

Discussion

Conclusion