Supplements Fracture Prevention in Osteoporosis
Managing Osteoporosis in a Managed Care Population
Improving Management Strategies
The faculty agreed that patient "buy-in" to the therapeutic regimen is essential for successful outcomes. It is critically important for the patient to understand that the treatment of osteoporosis will require longterm therapy and strict adherence to the therapeutic regimen prescribed. Evidence of low BMD and increased 10-year fracture risk may act as motivating factors to improve adherence in some patients. Because of a typically heavy workload among case managers, intensive case management of higherrisk patients was viewed by the panel as impractical. Suggested as 1 alternative, automated outbound phone systems can be used as a tool for reminding patients to adhere to their treatment regimen. In addition, after hospitalization, postdischarge follow-up calls can also be used to ensure that the patient is adhering to therapy. Because of limited resources, case management efforts are usually of low intensity, but the faculty agreed that they should not be completely absent. Patients at higher risk for fracture may already be participating in case management or disease management programs for other conditions, and, once these patients are identified, those programs can easily be enhanced to offer services and follow-up targeting fracture reduction. Another management strategy offered was to ensure that orthopedic surgeons and primary care physicians are aware of the importance of treating both vertebral and nonvertebral postfracture patients from discharge forward, a step that is consistent with HEDIS requirements, and that these patients receive postdischarge phone contacts to bolster adherence.
Inexorable long-term demographic changes and the recent implementation of a Medicare drug program should propel increasing numbers of elderly patients into managed healthcare. The inclusion of such large populations of patients at higher risk for osteoporosis and, in turn, fracture should compel MCOs to elevate the prevention and treatment of osteoporosis- related fracture to high-priority status. In this context, the cost-effective management of osteoporosis and prevention of fracture are paramount considerations. The use of bisphosphonates, because of their clear efficacy, remains a key step in reducing the risks for osteoporosis-related fracture. Yet, measures of the cost effectiveness for a specific bisphosphonate therapy should not be restricted to the cost savings resulting from reductions in fracture risk alone, but should include a consideration of the differences among bisphosphonate products in terms of onset of action and tolerability, especially the incidence of bisphosphonate-related gastrointestinal effects, as potential cost variables. For managed care, screening to identify patients at higher risk for osteoporosis-related fracture and implementing prevention programs that include lifestyle changes and the most cost-effective osteoporosis treatment options are essential for stemming the anticipated substantial increase in the health plan cost of treating fractures and its debilitating consequences.
Corresponding author: Diana Brixner, PhD, RPh, Associate Professor and Chair, Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, UT. E-mail: firstname.lastname@example.org.