SAT-534 How Has Bisphosphonate Prescribing Changed in the Past Decade for Primary Fracture?

Abstract

INTRODUCTION: The importance of bisphosphonate drugs (BP) in preventing fractures is well known. Initial guidelines focused on early primary prevention of fracture for postmenopausal women using a BMD T-score -2.0 or lower, regardless of age (T-score < -1.5 with risk factors). In 2008, national guidelines focused treatment on osteoporosis (T-score < -2.5) or osteopenia (-1 > T-score > -2.5) with high fracture risk based on FRAX. This study examines whether there has been a shift in the characteristics of women initiating BP therapy for primary prevention (no previous fracture) over time from 2002 to 2013. METHOD: We included female members age within an integrated healthcare delivery system who were age 50-79y, initiated oral BP in 2002-2013, and had BMD measured within the 2 previous years. Women with fracture history (except head, fingers, toes), metastatic cancer, and advanced kidney disease were excluded. Age at BP initiation, race/ethnicity, and the proportions with normal BMD (T-score > -1), osteopenia, and osteoporosis each year and within earlier (2002-2007) and later (2008-2013) treatment eras were examined. Analyses were also stratified by race/ethnicity. RESULTS: 28,495 women age 50-79y (mean age 66y; 56% non-Hispanic White, 27% Asian, and 17% all others) met inclusion criteria. For each year from 2002-2013, the proportions of women <65y declined as the proportions >65y increased among those initiating BP. By age decade, the proportion 50-59y declined from 31% to 12%, while the proportion 60-69y and 70-79y increased from 39% to 54% and 29% to 34%, respectively, from 2002-2013. In 2013, the predominant age group initiating BP was 60-69y (54% overall; 51% in whites, 63% in Asians). During this same period, the percentage of women initiating BP who had osteoporosis progressively increased from 62% in 2002 to 79% in 2013. For whites, the overall percentage with osteoporosis was 65%, increasing from 58% in 2002 to 71% in 2013; for Asians, the percentage with osteoporosis was higher at 82%, increasing from 74% to 95% in these same years. Only among older women (70-79y) there appeared to be no temporal change (71% in 2002-2007 vs 69% in 2008-2013, p=0.1). DISCUSSION: Over time, there has been a remarkable shift in the type of woman initiating BP for primary prevention, from younger to older and from those with osteopenia to osteoporosis. By 2013, over half of the women initiating BP were 60-69y, and compared to 2002, there was a 27% higher prevalence of osteoporosis among women starting BP. Within the health plan, 13-15% of older women are Asian compared to 27% of our study population, indicating that Asians appear to be more likely to begin BP for primary prevention. Future studies should assess the impact of the observed shift in BP prescribing on fracture outcomes, focusing on the possible impact of age, race/ethnicity, and cost-effectiveness.