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Supplements Fracture Prevention in Osteoporosis
Managing Osteoporosis in a Managed Care Population
Christina Barrington, PharmD; Michael Baxley, MD; Luis Estevez, MD, MPH, MBA; John Fox, MD; Robert Gregory, RPh, MS, MBA; Sonya J. Lewis, RPh, MBA; Bonnie May, RPh, MBA; Bruce Niebylski, MD
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Assessment of the Prevalence and Costs of Osteoporosis Treatment Options in a Real-world Setting
Diana Brixner, PhD, RPh
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Introduction: Fracture Prevention
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Importance of Early Diagnosis and Treatment of Osteoporosis to Prevent Fractures
Joseph R. Tucci, MD

Importance of Early Diagnosis and Treatment of Osteoporosis to Prevent Fractures

Joseph R. Tucci, MD

Hormone Therapy: Hormone therapy (HT) is a long-established approach for the prevention and treatment of osteoporosis. Recent results from the Women's Health Initiative, which enrolled almost 11 000 postmenopausal women beginning in 1993, found that HT resulted in a reduction of 39%, 38%, and 30% in hip, vertebral, and total fractures, respectively, versus placebo.51 Unfortunately, a concurrent increase in the incidence of cardiovascular events, chiefly stroke, has cast a serious shadow over the future of HT as an option in the management of osteoporosis.

Conclusions

For managed healthcare, significant opportunities exist for reducing the costs of osteoporosis-related fractures by improving follow-up treatment for fractures and identifying other individuals with osteoporosis at high risk for fracture. Treatment of postfracture patients has been shown to be far less adequate than would be expected in such a high-risk group. Enhanced treatment in this easily identifiable group should yield substantially improved downstream clinical outcomes. A more daunting task, perhaps, is the identification of other groups at high-risk for fracture. BMD, as measured by T-scores, has demonstrated some correlation with fracture risk. Clearly, the preponderance of clinical evidence now requires a consideration of other risk factors–age, prior fracture, glucocorticoid use among others, in addition to BMD, as a means of assessing fracture risk. Administrative claims databases may provide a valuable source of patient information for screening. As a result of the Medicare Modernization Act of 2003, there may be an increased number of patients at risk for osteoporosis enrolling in Medicare Advantage health plans, heightening the importance of effective preventive measures and treatments, with a focus on high-risk populations to improve outcomes. To provide optimal management and cost effectiveness, patients at high risk for fracture will require the use of agents that not only impact BMD but also have demonstrated efficacy in reducing both vertebral and nonvertebral fractures as a major component of a proactive management plan.




Corresponding author: Joseph R. Tucci, MD, Chief, Division of Endocrinology, Roger Williams Medical Center, Providence, Rhode Island. E-mail: jrtuccimd@yahoo.com.


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