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Gender Disparities in Osteoporosis Screening and Management Among Older Adults

Abstract

Introduction

One in two women and one in four men experience an osteoporosis-related fracture in their lifetime. Related morbidity and mortality rates are higher in men versus women. Current guidelines are inconsistent in the screening recommendations for osteoporosis in men. Examination of gender disparities in the management of osteoporosis-related fractures among Medicare enrollees is currently lacking.

Methods

In this retrospective cohort study using 5% National Medicare claims data from January 1, 2012 through December 31, 2016, eligible patients who were at least 65 years of age on the date of a new fracture episode were classified into two mutually exclusive cohorts on the basis of whether they received testing and/or treatment for osteoporosis in the 6-month period after the new fracture episode. The cohorts were defined on the basis of the National Committee for Quality Assurance (NCQA) quality measure “osteoporosis management in women who had a fracture.” Patients were followed to identify the occurrence of subsequent fracture, all-cause mortality, and a composite outcome—defined as the first occurrence of either subsequent fracture or mortality. Logistic regression models were carried out to identify predictors of testing and/or treatment and time-varying survival analysis to identify the relationship between the presence of testing and/or treatment and patient outcomes.

Results

Of the 35,774 eligible patients, only 10.2% (12.1% women and 5.7% men) received osteoporosis testing and/or treatment within 6 months after a fracture. The interaction between gender and fragility fracture was significant (P < 0.0001). Fragility fracture had greater adjusted odds of testing and/or treatment among men (adjusted odds ratio [AOR] 3.47; 95% CI 2.94–4.10) than women (AOR 1.65; 95% CI 1.53–1.79). Of patients who were eligible for the outcome assessment, 27.5% experienced a subsequent fracture, 23.2% died, and 44.3% experienced a composite outcome during follow-up. Patients who received testing and/or treatment had a significantly lower hazard of all-cause mortality (hazard ratio [HR] 0.57; 95% CI 0.50–0.65; P < 0.0001) and the composite outcome (HR 0.42; 95% CI 0.39–0.45; P < 0.0001), but no difference in the risk of subsequent fracture (HR 1.02; 95% CI 0.94–1.11; P = 0.6083). Men were found to have a significantly lower hazard of subsequent fracture (HR 0.69; 95% CI 0.64–0.73; P < 0.0001), all-cause mortality (HR 0.67; 95% CI 0.61–0.72; P < 0.0001), and the composite outcome (HR 0.69; 95% CI 0.65–0.73; P < 0.0001).

Conclusion

Testing and/or treatment for osteoporosis among older adults with a fracture is poor in the Medicare fee-for-service population overall and worse for men compared to women. Receiving appropriate testing and/or treatment was associated with reduced mortality and the risk of composite outcome. Improving osteoporosis testing and/or treatment and reducing health disparities are essential for managing the clinical and economic burden of osteoporosis in the USA.

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Acknowledgements

Funding

Funding for this study and Rapid Service Fee were provided by Radius Health, Inc., Boston, USA.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authors’ contributions

Sujith Ramachandran, Setareh A. Williams, Richard J. Weiss, and Yamei Wang contributed to the study concept and design. Sujith Ramachandran contributed to the collection of the data. Sujith Ramachandran, Yiqiao Zhang, Irene Nsiah, and Kaustuv Bhattacharya contributed to the data analysis. Sujith Ramachandran, Setareh A. Williams, Richard J. Weiss, Yamei Wang, Yiqiao Zhang, and Irene Nsiah contributed to interpretation of data. Sujith Ramachandran and Yiqiao Zhang wrote the initial draft of the manuscript and all authors reviewed and provided comments. All authors approved of the final draft for submission and agree to be responsible for the content of this work.

Medical Writing/Editorial Assistance

Writing/Editorial support (Sarah Hummasti, PhD) and graphic services were provided by AOIC, LLC, and were funded by Radius Health, Inc.

Disclosures

Sujith Ramachandran, Yiqiao Zhang, Irene Nsiah, and Kaustuv Bhattacharya report that they or their institution has received research funding from Radius Health, Inc. in relation to this work. Sujith Ramachandran reports research funding from the National Institutes of Drug Abuse outside of this work. Setareh A. Williams, and Yamei Wang are employees and shareholders of Radius Health, Inc. Richard J. Weiss is a former employee and shareholder in Radius Health, Inc.

Compliance with Ethics Guidelines

The study was approved by the University of Mississippi’s Institutional Review Board (IRB protocol#20x-19) and the use of the data for this project was covered by a data use agreement with the centers for Medicare & Medicaid services (DUA#RSCH-2019-54123). The data used in this study are fully de-identified and HIPAA compliant, and therefore consent to participate and publish does not apply. Given the retrospective nature of the study design and the de-identified data, full review of the study procedures was conducted at the IRB, and a waiver of informed consent for participation and publication was approved. All study procedures were conducted as per the ethical principles in the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research.

Data Availability

Data underlying this study are available from the Centers for Medicare and Medicaid Services upon request.

Prior Presentation

Gender Disparities in Osteoporosis Screening & Management Among Older Adults Presented at the AMCP Nexus 2020 Virtual Meeting, October 19–23, 2020.

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Correspondence to Sujith Ramachandran.

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Ramachandran, S., Williams, S.A., Weiss, R.J. et al. Gender Disparities in Osteoporosis Screening and Management Among Older Adults. Adv Ther 38, 3872–3887 (2021). https://doi.org/10.1007/s12325-021-01792-w

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  • DOI: https://doi.org/10.1007/s12325-021-01792-w

Keywords

  • Osteoporosis treatment
  • Osteoporosis testing
  • Gender disparities
  • Fracture