Predictors of oral bisphosphonate prescriptions in post-menopausal women with osteoporosis in a real-world setting in the USA

SUMMARY: We identified factors associated with oral bisphosphonate treatment in 50+-year-old female patients with a first fracture, osteoporosis diagnosis, or BMD ≤−2.5 in the Geisinger Health System electronic health record database. Treatment was positively associated with age, oral corticosteroids, and smoking, and negatively associated with body mass index and bone mineral density scores. INTRODUCTION: To identify factors associated with oral bisphosphonate treatment in patients with an indicator for post-menopausal osteoporosis. METHODS: Females age 50+ years with a first fracture, osteoporosis diagnosis, or bone mineral density (BMD) ≤−2.5 (index date) were identified in the Geisinger Health System electronic health record database. Treatment was defined as an oral bisphosphonate prescription order (risedronate sodium, ibandronate sodium, or alendronate) ≤90 days post-index date. Treatment rates were assessed and a multivariate logistic model was used to identify predictors of treatment separately for patients with fracture (FRAC) and with diagnosis or low BMD (ICD-9-BMD). RESULTS: The FRAC group had 2,003 female patients with a mean (SD) age of 69.0 (±11.3) years and the ICD-9-BMD group had 12,976 female patients with a mean (SD) age of 66.9 (±10.0) years. Within 90 days of the index date of fracture, diagnosis, or low BMD score, 188 (9.4%) patients in the FRAC group and 5,395 (41.6%) in the ICD-9-BMD group received treatment. Treatment was positively associated with age and oral corticosteroids and negatively associated with body mass index and subsequent BMD in both groups. Smoking currently was positively associated with treatment in the ICD-9-BMD group. CONCLUSION: Certain patient characteristics are predictors of physicians prescribing oral bisphosphonates. However, many patients remain untreated.