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Abstract Number: 49

Long-Term Oral Bisphosphonate Use for Osteoporosis Among Older Women – US and Canadian Perspective

Nicole C. Wright1, Wilson Smith2, Amy H. Warriner3, Jeff Foster4, Ruth McConnell5, Huifeng Yun6, Mary H Melton7, Jeffrey R. Curtis4 and Kenneth G. Saag8, 1Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 2Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 3Endocrinology, Diabetes, and Metabolism, The University of Alabama at Birmingham, Birmingham, AL, 4The University of Alabama at Birmingham, Birmingham, AL, 5University of Alabama at Birmingham, Birmingham, AL, 6Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, 7Medicine, The University of Alabama at Birmingham, Birmingham, AL, 8Immunology & Rheumatology, The University of Alabama at Birmingham, Birmingham, AL

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Epidemiologic methods, osteoporosis and treatment

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Session Information

Title: Epidemiology and Public Health: Osteoporosis, Non-Inflammatory Arthritis and More

Session Type: Abstract Submissions (ACR)

Background/Purpose: Bisphosphonates (BPs) have been widely used for the treatment and prevention of osteoporosis for two decades. Although new parenteral preparations have been introduced, oral BPs still represent the vast majority of osteoporosis treatments. Little is known about the characteristics of or regional differences in long-term oral BP users.

Methods: We evaluated the long-term use of oral BPs in the national US Medicare and Ontario (ON) Canada data systems. The US Medicare cohort consisted of women aged ≥65 years with an osteoporosis or fracture diagnosis code, or BP prescription fill. The ON data consisted of women aged ≥66 years who were new users of oral BPs. We identified women with three years of continuous medical and pharmacy coverage. Long-term BP users were those with exposure to an oral BP (alendronate, risedronate, ibandronate, and etidronate) in each of the three most recent years of available data (2009-2011). We evaluated demographic and BP utilization data including, BP exclusivity (no exposure to another BP agent in three year period) and compliance to therapy using proportion of days covered (PDC) (days of drug supplied in 3 years/3*365.25) . Users with a PDC of ≥70% were considered compliant. 

Results: We identified 888,704 US and 99,530 ON women meeting the inclusion criteria with at least one oral BP prescription in the most recent data. We then identified 698,012 US and 54,656 ON long-term oral BPs users (Table). Alendronate was primarily used by Medicare patients (78.0%), whereas risedronate was the primary oral BP in ON (56%). Based on the available data, the mean duration of us among the long-term BP users was five years in both US (SD: 1.1) and ON (SD: 2.2). In the US, risedronate users were more likely to be exclusive users (83%) compared to alendronate users; whereas in ON, a higher proportion of alendronate users were considered exclusive users than risedronate users. All ibandronate users were exclusive users in US data. Compliance was higher in ON (80% alendronate, 78% risedronate) than in US (63% alendronate, 63% risedronate).

Conclusion:  Although alternative preparations of BPs and new non-BP drugs have emerged in the market, the prevalence of oral BP use is high. In the data evaluated, the prevalence of long-term use (≥3years), was also high in both countries. However, compliance differed by country. Evaluations in more recent data would determine if and how drug holidays have altered these characteristics.

Table. Characteristics of Long-term Oral Bisphosphonate Users

 

US, 2009-2011

(n=698,012)

ON, 2009-2011

(n=54,656)

Age, mean (SD)

79.3 (7.4)

74.0 (6.4)

Mean BP durationa, yrs (SD)

5.0 (1.1)

4.9 (2.2)

Most recent BP, (n,%)

Alendronate

Risedronate

Ibandronate

544,656 (78.0)

96,795 (13.9)

56,561 (8.1)

24,056 (44.0)

30,600 (56.0)

–

Exclusive BP usersb, (n,%)

Alendronate

Risedronate

Ibandronate

419,496 (77.2)

80,314 (83.0)

56,561 (100.0)

22,596 (93.9)

26,981 (88.2)

–

Compliant BP usersc, (n,%)

Alendronate

Risedronate

Ibandronate

262,125 (62.5)

50,880 (63.4)

33,981 (60.1)

18,173 (80.4)

20,981 (77.8)

–

aMean duration based on first BP dispensed in each data system. US = 2006-2011; ON: 2002-2011

bExclusive users are those who only filled a prescription for each oral BP among most recent BP users

cCompliance estimated at proportion of days covered (PDC) of ≥70% among exclusive BP users


Disclosure:

N. C. Wright,
None;

W. Smith,
None;

A. H. Warriner,
None;

J. Foster,
None;

R. McConnell,
None;

H. Yun,
None;

M. H. Melton,
None;

J. R. Curtis,
None;

K. G. Saag,
None.

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