WASHINGTON – Less than one in 10 commercially insured patients in the United States who broke a hip, a major complication of osteoporosis, will receive any osteoporosis medical treatment within two-quarters of a calendar of their fractures, according to a study that its results will be presented at ENDO 2021, the annual meeting of the Endocrine Society.
Treatment rates with osteoporosis, or bone loss, medications have dropped dramatically in the past decade from 15 percent to 8 percent, a new study of a large nationwide private insurance database found. The decline comes despite the fact that fractures are often the first sign of osteoporosis, said the study’s lead author, Sara Cromer, MD, an endocrinology associate at Massachusetts General Hospital in Boston, Mass.
“This very low level of treatment with bone-directed medications to prevent future fractures is a cause for concern,” Cromer said. “This is like giving any treatment to lower blood pressure or lowering cholesterol after a heart attack. “
Medical associations recommend the assessment and treatment of osteoporosis after hip fractures. Osteoporosis medications, also known as bone-directed drugs or bone modification, prevent bones from becoming weakened by slowing down a natural bone fracture or by stimulating new bone to break down. creation.
Some 54 million Americans – mostly women – have osteoporosis or are at risk of the bone-weakening disease, putting them at increased risk of broken bones, according to the Hormone Health Network. Each year, more than 300,000 older adults nationwide maintain a hip fracture that requires hospitalization, according to the U.S. Centers for Disease Control and Prevention.
The new study included more than 15 million drug claims and reviewed trends in U.S. prescribing of bone therapies from 2009 to 2020. Although the study data do not address potential causes being there for the reduction in bone treatment of hip fractures, Cromer said the diagnosis of osteoporosis is often overlooked, even in patients suffering from fractures that explain diseases.
Another reason could be public concerns about the side effects of some common osteoporosis drugs, including bisphosphonates, she suggested. These include the rare possibility of either hook osteonecrosis, which is a major fracture of a bone in the chisel, or of broken bones.
The Society’s Clinical Practice Guidelines for the Treatment of Osteoporosis in Postmenopausal Women state that the benefits of bone-directed medications outweigh the risk to women at risk of bone fracture, particularly those who have suffered a fracture. recently.
“The risk of a second fracture is higher without osteoporosis medications,” Cromer said. “Also, hip fractures can be fatal, with about 20-30 percent of people dying within a year after a hip fracture, and studies show that some medications for osteoporosis can even reduce the risk of this death. ”
Another move cited by their study is what Cromer said seems to be in line with the Society’s management recommendations of the rapid increase in denosumab use, which came into being in 2010. This treatment, which has been given passed twice a year as an injection in the doctor’s office, the monoclonal antibody that acts similar to bisphosphonates. The guideline recommends denosumab as an alternative to bisphosphonates for the initial treatment of osteoporosis if they are unable to take bisphosphonates or are at high risk of osteoporotic fracture.
By 2017, denosumab use was surpassing all other bone-borne drugs except the alendronate bisphosphonate for the treatment of osteoporosis, the study data showed. In addition, Cromer said that by 2013 denosumab became the most common drug for preventing fractures associated with cancers that are, or are likely to spread to the bone.
“While denosumab is extremely effective in improving bone density and preventing fractures, it has also been known for several years that there is an increase in spinal fractures if denosumab is discontinued without follow-up treatment, and sometimes even with follow – up treatment, “Cromer said. “This safety concern does not appear to be evident in drug use as early as 2020, the end of our study.”
Cromer acknowledged that denosumab may be more popular than other effective medications because its administration form – injected twice a year – is more appropriate than the oral form of bisphosphonates taken by patients. once a week. However, she said denosumab was used more often than zoledronic acid, an intravenous bisphosphonate that requires only doses once a year. The reasons for the rapid increase in denosumab use remain unclear, she noted.
She encouraged patients with osteopenia or osteoporosis to discuss the risks and benefits of treatment with their doctor and ask which medication is best for them.
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