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Abstract Number: 2564

Providing Optimal and Equitable Osteoporosis Treatment Using a Programmatic Approach -A 20 Year Longitudinal Study

Nneka Chukwu1, Lillian Chang2, Thomas Olenginski3, Hema Srinivasan4, Idorenyin Udoeyo2, David Pugliese5, Andrea Berger2 and Jonida Cote6, 1Geisinger Medical Center, Danville, PA, Danville, PA, 2Geisinger Medical Center, Danville, PA, 3Geisinger, Lewisburg Pennsylvania 17837, PA, 4Geisinger Medical Center, Danvile, PA, 5Geisinger Health System, Wilkes-Barre, PA, 6Geisinger Medical Center, Orefield, PA

Meeting: ACR Convergence 2024

Keywords: osteoporosis

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Session Information

Date: Monday, November 18, 2024

Title: Abstracts: Osteoporosis & Metabolic Bone Disease – Basic & Clinical Science

Session Type: Abstract Session

Session Time: 1:00PM-2:30PM

Background/Purpose: Osteoporosis remains poorly identified and treated. We studied the effects of an organized osteoporosis program of care on treatment rates over a 20-year period.

Methods: In 2008, we built an osteoporosis program with consultative DXA reporting, reliable identification of high-risk patients, and in/outpatient osteoporosis services. A retrospective study examined 3- and 5-year treatment trends in our osteoporosis population through seven 3-year time periods, 2002-2022. Eligibility criteria had patients ≥50 years with ≥1 PCP visit and ≥1 high risk DXA in each period. 3-year therapy was defined as patient on active or having ≥3-years of treatment in each period. 5-year therapy was defined as active or having ≥5 years of treatment. Active therapy was defined as on oral bisphosphonate or anabolic by period end date, denosumab within the last 8-months, or zoledronate in the last 14-months of the period. Treatment comparisons were made by insurance, visit type (PCP vs non-PCP) race, age, and gender. The non-PCP group involved specialty [Rheumatology or Endocrinology] clinic and osteoporosis clinic. A sub-analysis compared treatment rates of our osteoporosis clinic to the PCP and specialty group. Chi-square or Fisher exact tests were used.

Results: Population included 44,135 patients with median age 76, white (98.1%), women (90.5%), Medicare (85.8%) and PCP managed (71.9%).  3- and 5-year treatment trends declined from period 1 to 7 (73.9 to 56.5%, p< 0.0001), (72.7% to 47.4%, p< 0.0001) respectively coinciding with national decline in osteoporosis treatment rates (Figure 1). Our treatment rate far exceeds a retrospective study of 48,668 patients 60-80 years old with < 20% screening/treatment rates pre-fracture (Ross et al, 2021; doi:10.2106/JBJS.OA.20.00142). Overall treatment was equitable independent of Medicare or Medicaid insurance type for the 3-year (59.3% vs 57.8%, p=0.40) and 5-year (51.1% vs 50.7%, p=0.84) groups with similar pattern in period 1-7 (Table 1). Overall 3- and 5-year treatments with the osteoporosis clinic were superior to the specialty clinic (70.2% vs 67.2%, p=0.0003), (60.2% vs 57.9%, p=0.012) respectively. Similarly, overall 3- and 5-year treatments with the osteoporosis clinic were superior to the PCP alone (70.2% vs 56.1%, p< 0.0001), (60.2% vs 48.5%, p< 0.0001) respectively. This pattern was seen in each period except period 7 where the osteoporosis clinic and specialty group performed similarly during the COVID-19 pandemic (Table 2). The 5-year overall treatment rate was equitable independent of race, but statistically better for women and younger patients (50-64 years old).

Conclusion: This is a unique 20-year study of 3- and 5-year osteoporosis treatment rates (59.7%, 51.5%) with involvement of a focused osteoporosis program for easy identification and treatment of high-risk patients. The osteoporosis clinic care was superior to the PCPs and specialty clinic. Treatment was equitable independent of insurance or race. By using a specialized osteoporosis clinic and a personalized DXA report with embedded diagnosis and treatment recommendations, we created a unique care structure that serves to bridge the osteoporosis care gap and is easily replicable.

Supporting image 1

Figure 1. Treatment Trends of the Three-Year and the Five-Year Osteoporosis Population over 2 Decades Compared to Retrospective Study by Ross et al. 2021

Supporting image 2

Supporting image 3

Table 2. Superiority of the Osteoporosis Clinic in the Three- and Five-Year Osteoporosis Treatment Trend by Specialty over a 20-year Longitudinal Study


Disclosures: N. Chukwu: None; L. Chang: None; T. Olenginski: None; H. Srinivasan: None; I. Udoeyo: None; D. Pugliese: None; A. Berger: None; J. Cote: None.

To cite this abstract in AMA style:

Chukwu N, Chang L, Olenginski T, Srinivasan H, Udoeyo I, Pugliese D, Berger A, Cote J. Providing Optimal and Equitable Osteoporosis Treatment Using a Programmatic Approach -A 20 Year Longitudinal Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/providing-optimal-and-equitable-osteoporosis-treatment-using-a-programmatic-approach-a-20-year-longitudinal-study/. Accessed .
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