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Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis

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Abstract

Summary

Among 95,057 patients ≥50 years with new anti-osteoporosis medications (AOM) (2001–2013) in primary care, 1-year cessation was 51% (28%–68%), higher in men, smokers, patients with missing lifestyle data, and out normal BMI, and lower in those aged 60–79, with recent fractures or other anti-osteoporotics, suggesting non-severe osteoporosis and less risk awareness.

Purpose

Low compliance to anti-osteoporosis medications (AOM) has been previously reported. We aimed to estimate 1-year cessation rates of different AOMs as used in Spanish healthcare settings, and to identify associated risk factors.

Methods

A cohort study was performed using primary care records data (BIFAP). Patients entered the cohort when aged 50 years in 2001–2013, with ≥1 year of data available, and identified as incident users of AOM (1-year washout). Participants were divided into six cohorts: alendronate, other oral bisphosphonates, selective oestrogen receptor modulators, strontium ranelate, teriparatide, and denosumab. Patients were followed from therapy initiation to the earliest of cessation (90-day refill gap), switching (to alternative AOM), loss to follow-up, death, or end of 2013. One-year therapy cessation was estimated using life tables. Hazard ratios (of cessation) according to age, sex, lifestyle factors, morbidity, and co-medication were estimated after stepwise backwards selection.

Results

A total of 95,057 AOM users were identified (91% women; mean age 68). One-year cessation was 51% overall, highest for strontium ranelate (68%), and lowest for denosumab (28%). Cessation probability was higher in men (14% to 2.1-fold), smokers (>6%), and patients with missing BMI (19–28%) or smoking (6–20%) data, and overweight/obese/underweight (7% to 2.6-fold increase compared to normal weight). Patients aged 60–79 years, with a recent fracture or other drugs used for osteoporosis, had better persistence.

Conclusions

Over half of the patients initiating AOM stopped therapy within the first year after initiation. The described risk factors for cessation could be proxies for non-severe osteoporosis, and/or disease/risk awareness, which could inform the targeting of high-risk patients for monitoring and/or interventions aimed at improving persistence.

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Acknowledgements

Authors would like to acknowledge the excellent collaboration of general practitioners and paediatricians and the support of regional governments taking part in BIFAP.

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Authors and Affiliations

  1. Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain

    Elisa Martín-Merino, Consuelo Huerta-Álvarez & Dolores Montero-Corominas

  2. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

    Daniel Prieto-Alhambra

  3. Grup de Recerca en Malalties Prevalents de l’Aparell Locomotor (GREMPAL) Research Group, IDIAP Jordi Gol Primary Care Research Institute, and CIBERFES, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Universitat Autònoma de Barcelona, Instituto de Salud Carlos III, Barcelona, Spain

    Daniel Prieto-Alhambra

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  1. Elisa Martín-Merino
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Correspondence to Elisa Martín-Merino.

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Conflicts of interest

DPA’s research group has received unrestricted research grants from Servier Laboratoires, UCB Pharma, and AMGEN. All other authors declare that they have no conflict of interest. The views expressed here do not necessarily represent the views of the co-authors’ respective organizations.

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Martín-Merino, E., Huerta-Álvarez, C., Prieto-Alhambra, D. et al. Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis. Arch Osteoporos 12, 39 (2017). https://doi.org/10.1007/s11657-017-0331-6

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