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Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women

Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women
Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women

Summary: Studies examining real-world effectiveness of osteoporosis therapies are beset by limitations due to confounding by indication. By evaluating longitudinal changes in fracture incidence, we demonstrated that osteoporosis therapies are effective in reducing fracture risk in real-world practice settings. Introduction: Osteoporosis therapies have been shown to reduce incidence of vertebral and non-vertebral fractures in placebo-controlled randomized clinical trials. However, information on the real-world effectiveness of these therapies is limited. Methods: We examined fracture risk reduction in older, post-menopausal women treated with osteoporosis therapies. Using Medicare claims, we identified 1,278,296 women age ≥ 65 years treated with zoledronic acid, oral bisphosphonates, denosumab, teriparatide, or raloxifene. Fracture incidence rates before and after treatment initiation were described to understand patients’ fracture risk profile, and fracture reduction effectiveness of each therapy was evaluated as a longitudinal change in incidence rates. Results: Fracture incidence rates increased during the period leading up to treatment initiation and were highest in the 3-month period most proximal to treatment initiation. Fracture incidence rates following treatment initiation were significantly lower than before treatment initiation. Compared with the 12-month pre-index period, there were reductions in clinical vertebral fractures for denosumab (45%; 95% confidence interval [CI] 39–51%), zoledronic acid (50%; 95% CI 47–52%), oral bisphosphonates (24%; 95% CI 22–26%), and teriparatide (72%; 95% CI 69–75%) during the subsequent 12 months. Relative to the first 3 months after initiation, clinical vertebral fractures were reduced for denosumab (51%; 95% CI 42–59%), zoledronic acid (25%; 95% CI 17–32%), oral bisphosphonates (23%; 95% CI 20–26%), and teriparatide (64%; 95% CI 58–69%) during the subsequent 12 months. Conclusion: In summary, reductions in fracture incidence over time were observed in cohorts of patients treated with osteoporosis therapies.

Anabolics, Antiresorptives, Effectiveness, Fracture risk reduction, Osteoporosis
1862-3522
1-10
Yusuf, Akeem A.
c16ed392-90cb-4915-a908-063f6e77ac29
Cummings, Steven R.
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Watts, Nelson B.
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Feudjo, Maurille Tepie
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Sprafka, J. Michael
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Zhou, Jincheng
d38acdbd-c61f-47db-8c2d-6b3387455138
Guo, Haifeng
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Balasubramanian, Akhila
2ed35a9e-f3ee-4525-be09-6c6d3b575b4a
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Yusuf, Akeem A.
c16ed392-90cb-4915-a908-063f6e77ac29
Cummings, Steven R.
7b3d4b1b-5ae4-40fd-b3e3-ee964e0703f0
Watts, Nelson B.
5c0d14e9-020d-4e1f-802a-163636c5f0ea
Feudjo, Maurille Tepie
8bf6cb59-50e2-427d-aa4c-3e08e841e077
Sprafka, J. Michael
56ed076a-7aeb-4289-a048-fee03287e516
Zhou, Jincheng
d38acdbd-c61f-47db-8c2d-6b3387455138
Guo, Haifeng
e1823858-ada2-4f15-9cb9-746e2b558058
Balasubramanian, Akhila
2ed35a9e-f3ee-4525-be09-6c6d3b575b4a
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6

Yusuf, Akeem A., Cummings, Steven R., Watts, Nelson B., Feudjo, Maurille Tepie, Sprafka, J. Michael, Zhou, Jincheng, Guo, Haifeng, Balasubramanian, Akhila and Cooper, Cyrus (2018) Real-world effectiveness of osteoporosis therapies for fracture reduction in post-menopausal women. Archives of Osteoporosis, 13 (1), 1-10, [33]. (doi:10.1007/s11657-018-0439-3).

Record type: Article

Abstract

Summary: Studies examining real-world effectiveness of osteoporosis therapies are beset by limitations due to confounding by indication. By evaluating longitudinal changes in fracture incidence, we demonstrated that osteoporosis therapies are effective in reducing fracture risk in real-world practice settings. Introduction: Osteoporosis therapies have been shown to reduce incidence of vertebral and non-vertebral fractures in placebo-controlled randomized clinical trials. However, information on the real-world effectiveness of these therapies is limited. Methods: We examined fracture risk reduction in older, post-menopausal women treated with osteoporosis therapies. Using Medicare claims, we identified 1,278,296 women age ≥ 65 years treated with zoledronic acid, oral bisphosphonates, denosumab, teriparatide, or raloxifene. Fracture incidence rates before and after treatment initiation were described to understand patients’ fracture risk profile, and fracture reduction effectiveness of each therapy was evaluated as a longitudinal change in incidence rates. Results: Fracture incidence rates increased during the period leading up to treatment initiation and were highest in the 3-month period most proximal to treatment initiation. Fracture incidence rates following treatment initiation were significantly lower than before treatment initiation. Compared with the 12-month pre-index period, there were reductions in clinical vertebral fractures for denosumab (45%; 95% confidence interval [CI] 39–51%), zoledronic acid (50%; 95% CI 47–52%), oral bisphosphonates (24%; 95% CI 22–26%), and teriparatide (72%; 95% CI 69–75%) during the subsequent 12 months. Relative to the first 3 months after initiation, clinical vertebral fractures were reduced for denosumab (51%; 95% CI 42–59%), zoledronic acid (25%; 95% CI 17–32%), oral bisphosphonates (23%; 95% CI 20–26%), and teriparatide (64%; 95% CI 58–69%) during the subsequent 12 months. Conclusion: In summary, reductions in fracture incidence over time were observed in cohorts of patients treated with osteoporosis therapies.

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10.1007%2Fs11657-018-0439-3 - Version of Record
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Accepted/In Press date: 19 February 2018
e-pub ahead of print date: 21 March 2018
Published date: 1 December 2018
Keywords: Anabolics, Antiresorptives, Effectiveness, Fracture risk reduction, Osteoporosis

Identifiers

Local EPrints ID: 419197
URI: http://eprints.soton.ac.uk/id/eprint/419197
ISSN: 1862-3522
PURE UUID: 4db52575-850e-4783-9184-696b0ed9e588
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 09 Apr 2018 16:30
Last modified: 18 Mar 2024 02:46

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Contributors

Author: Akeem A. Yusuf
Author: Steven R. Cummings
Author: Nelson B. Watts
Author: Maurille Tepie Feudjo
Author: J. Michael Sprafka
Author: Jincheng Zhou
Author: Haifeng Guo
Author: Akhila Balasubramanian
Author: Cyrus Cooper ORCID iD

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