Bisphosphonates Are Increasingly Prescribed to Those Most Likely to Benefit

Drugs used to treat osteoporosis and prevent fractures are now being used more effectively in a population more likely to benefit, according to results presented at ENDO 2019, the Endocrine Society’s annual meeting.

The researchers found that prescribing patterns for bisphosphonates have changed in recent years, with more older women receiving the treatment compared with more younger women, who received the treatment in the past.

"Bisphosphonate drugs have been first-line therapy for osteoporosis and fracture prevention for more than 20 years; however, osteoporosis care has changed over the past decade. Instead of treating younger, healthier women at low risk for fracture, the medical community now focuses on treating older women and those with bone density and other factors that indicate high risk for future fracture," senior study author Joan Lo, MD, of Kaiser Permanente Northern California Division of Research, said in a statement.

The researchers reviewed records of 28,495 women who were members at the integrated Kaiser Permanente Northern California healthcare system. The women included in the study were between the ages of 50 and 79 and had initiated bisphosphonate therapy between 2002 and 2013. They also underwent a bone mineral density test in the previous 2 years, had no history of fracture (except for head, fingers, and toes), and did not have advanced kidney disease or metastatic cancer.

Each year during the study period, the percentage of younger women on bisphosphonates dropped while the percentage of older women on the treatment increased. By the end of the study period, more than half (54%) of women between the ages of 60 and 69 had initiated bisphosphonates, up from 39% at the beginning. The percentage of women between the ages of 70 and 79 who initiated treatment also rose (39% to 34%). Meanwhile, the percentage of women between the ages of 50 and 59 who initiative treatment dropped significantly (31% to 12%).

They also found that the change in prescribing patterns also included fewer women with osteopenia starting on bisphosphonates and more women with osteoporosis starting treatment.

"These findings reflect the success of regional initiatives targeting these potent therapies to those who will benefit the most," Lo said. “In response to national guidelines and quality metrics introduced in 2008, we are doing a better job of giving more appropriate drug treatment to women who are most likely to benefit while avoiding excess treatment of women at low risk for fracture.”