Background/Purpose: The National Osteoporosis Foundation (NOF) published treatment guidelines to help guide clinicians on which patients should be considered for osteoporosis (OP) therapy. We examined patient factors associated with non-concordance among older adults participating in the PAADRN study.       

Methods: The PAADRN study (NCT01507662) is a large, NIH funded, randomized trial currently being conducted in the Iowa City, IA, Birmingham, AL, and Atlanta, GA metro areas. Immediately following DXA, participants ≥50 years of age are recruited and randomized. We used data from the control arm, usual care group, (n=2,711 as of 6/14/14) for our analyses. We defined guideline concordant OP therapy as the report of any FDA approved OP therapy at the 12-week post-DXA survey along with one of the following criteria: 1) baseline self-report of fracture after the age of 40, 2) T-score at or below the OP threshold (<-2.5), or 3) T-score within the low bone mass range (-1.5 to -2.5) and a FRAX score ≥20%. Non-concordance was examined among participants who 1) were indicated for OP therapy who did not report OP therapy at 12 weeks (N=1,170), and 2) were not indicated for OP therapy who reported OP therapy at 12 weeks (N=1,541). We used logistic regression to assess the association of baseline demographic and comorbidity factors with non-concordance in both groups.   

Results: Our study population was 85% female, 20% from minority backgrounds, and 60% ≥ 65 years of age. At baseline, 760 (28%) reported having a fracture after 40 years of age, 576 (21%) had DXA defined OP, and 188 (7%) had low bone mass with a FRAX ≥ 20%. At the 12-week survey, 38% of patients with indications for OP therapy reported medication use, and 15% of patients without indications for OP therapy reported medication use. When treatment was indicated, we found that being Black was associated with higher odds of treatment non-concordance in the crude analyses (Table). Factors associated with higher odds of non-concordance among those not indicated for treatment included: being a woman, Hispanic, having comorbidities related to secondary OP, being a pre-menopausal woman, the self-report of low bone mass and OP, calcium and multi-vitamin supplementation use, and having spoken to provider by 12-week survey (Table).

Conclusion: In this study of usual OP treatment, 38% of those indicated for OP treatment reported medication use, and 15% of those not indicated for treatment reported medication use. We found that race was associated with non-concordance when treatment was indicated. When treatment was not indicated, non-concordance was associated with conditions related to low BMD, potentially being used as preventative therapy. However, demographic and lifestyle factors were also associated with high non-concordance in this group, suggesting that additional education on the benefits and risks of OP therapies for both patients and providers is needed.