Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis

R. A. Overman; M. L. Gourlay; C. L. Deal; J. F. Farley; M. A. Brookhart; J. B. Layton

doi:10.1007/s00198-014-3022-9

Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis

R. A. Overman, M. L. Gourlay, C. L. Deal, J. F. Farley, M. A. Brookhart, J. B. Layton

Pharmaceutical Care and Health Systems

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Summary: Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.

Introduction: The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.

Methods: A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.

Results: Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.

Conclusions: AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.

Original language	English (US)
Pages (from-to)	1515-1524
Number of pages	10
Journal	Osteoporosis International
Volume	26
Issue number	5
DOIs	https://doi.org/10.1007/s00198-014-3022-9
State	Published - May 1 2015

Keywords

Anti-osteoporosis medication
Glucocorticoid-induced osteoporosis
Osteoporotic fracture
Quality measures

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@article{30039d0acf264ba6bb4dfb2de1395a66,

title = "Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis",

abstract = "Summary: Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.Introduction: The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.Methods: A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.Results: Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.Conclusions: AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.",

keywords = "Anti-osteoporosis medication, Glucocorticoid-induced osteoporosis, Osteoporotic fracture, Quality measures",

author = "Overman, {R. A.} and Gourlay, {M. L.} and Deal, {C. L.} and Farley, {J. F.} and Brookhart, {M. A.} and Layton, {J. B.}",

year = "2015",

month = may,

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doi = "10.1007/s00198-014-3022-9",

language = "English (US)",

volume = "26",

pages = "1515--1524",

journal = "Osteoporosis International",

issn = "0937-941X",

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TY - JOUR

T1 - Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis

AU - Overman, R. A.

AU - Gourlay, M. L.

AU - Deal, C. L.

AU - Farley, J. F.

AU - Brookhart, M. A.

AU - Layton, J. B.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Summary: Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.Introduction: The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.Methods: A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.Results: Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.Conclusions: AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.

AB - Summary: Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.Introduction: The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.Methods: A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.Results: Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.Conclusions: AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.

KW - Anti-osteoporosis medication

KW - Glucocorticoid-induced osteoporosis

KW - Osteoporotic fracture

KW - Quality measures

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