PSAT156 Abaloparatide Implementation and Follow-Up: Real-World Results of a Pharmacist-Run Anabolic Osteoporosis Clinic

Abstract

Abstract Introduction Osteoporosis, the most common bone disorder worldwide, is associated with increased morbidity and mortality. Available treatments include antiresorptive agents and anabolic therapies. Anabolic therapies are indicated in patients at high risk of osteoporotic fracture. There are challenges to utilizing anabolic therapies, however, including providing training on injection technique, addressing patient concerns about medication safety, and completion of medication prior authorizations. Pharmacist involvement could help ensure the safe and effective use of anabolic therapy. Objective To describe the 4-year, real-world results of a pharmacist-run abaloparatide osteoporosis clinic. Methods The primary study endpoint was the comparison of DXA T-scores and BMD values of the total hip, femoral neck, spine, and 1/3 radius (wrist) at baseline, after abaloparatide therapy, and following 1 year of follow-up antiresorptive therapy. The secondary end point was the number of documented fractures. Each patient served as his/her own control. Paired T-tests were performed to compare mean differences in pre- and post- T-scores and BMD values. Results Between April 2017 and October 2021, 146 patients were referred for abaloparatide therapy, with 91 patients (62.3%) initiating therapy. Eighteen patients refused to begin therapy because of concerns of adverse drug reactions, lack of interest in treating their osteoporosis, or because of the route of drug administration. Other consenting patients did not initiate therapy due to high monthly co-pay costs (15), insurance preferring teriparatide (1), insurance refusing coverage of any anabolic therapy (1), and contraindication to abaloparatide therapy (10). The average age at initiation of therapy was 66.7 (+ 7.7) years, 97.8% were women, 98.9% were Caucasian, mean BMI was 25.2 (+ 6.0), 56% had a history of osteoporotic fracture, baseline T-Scores of the femoral neck and spine were -2.5 (+ 0.7), and -2.4 (+ 1.3), respectively, and 49.5% of patients were osteoporosis drug naïve. There were significant improvements in T-scores and BMD at the spine, total hip and femoral neck during an average of 12 + 2 months (range 9–18 months) of abaloparatide therapy, and a significant decrease in T-score at the 1/3 radius. All patients received follow-up antiresorptive therapy, with 84.1% of patients receiving denosumab. After 1 year of antiresorptive therapy, significant increases in T-scores and BMD were seen at the total hip and lumbar spine, with nonsignificant changes in the femoral neck and 1/3 radius. There was one reported fracture during the evaluation period. Eighteen patients (19.8%) discontinued therapy due to an ADR. Conclusion Abaloparatide is effective in increasing BMD and T-scores and in preventing osteoporosis-related fractures. The fact that 37.7% of referred patients did not initiate therapy, indicates that significant barriers to anabolic osteoporosis treatment remain. Noteworthy, however, is the achieved 72.5% persistence rate of the patients initiating abaloparatide at this pharmacist-run anabolic osteoporosis clinic. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.