Abstract
Summary
The study investigated the real-world relationship between teriparatide adherence and persistence and fracture outcomes in a US claims database. Fracture risk was estimated to decrease as adherence and persistence increased for any clinical, vertebral, and non-vertebral fractures. Greater emphasis on programs to increase patient adherence may improve clinical outcomes.
Introduction
Adherence to osteoporosis treatment is essential for achieving optimal therapeutic outcomes. Previous findings from clinical trials and observational studies demonstrate that longer teriparatide (TPTD) exposure is associated with fewer fractures. The study aim was to investigate real-world relationships between TPTD adherence and persistence and fracture outcomes.
Methods
The Thomson Reuters MarketScan® database, 2004–2008, was used to identify TPTD users with continuous enrollment 12 months pre- and 24 months post-TPTD initiation. Post-index fractures included vertebral and non-vertebral. Adherence (medication possession ratio, MPR) groups were defined as high (MPR ≥ 0.80), medium (0.5 ≤ MPR < 0.8), and low (MPR < 0.5). Persistence groups were defined by periods 1–6, 7–12, 13–18, and 19–24 months. Logistic regressions modeled fracture risk for any clinical, hip, vertebral, and non-vertebral fractures, controlling for patient characteristics, insurance and healthcare provider types, Charlson comorbidity index, bone mineral density screening, medication use, and fracture history.
Results
Among 3,587 TPTD patients (mean age 68.9 years; 91% female), fracture risk was lowest in high MPR patients in all models except hip (OR = 1.17; p = 0.64). Medium versus high MPR was a significant risk factor for any fracture (OR = 1.49; p = 0.004) and non-vertebral fracture (OR = 1.45; p = 0.014); low-MPR was a significant risk factor for any fracture (OR = 1.64; p < 0.01), vertebral fracture (OR = 2.56; p = 0.001), and non-vertebral fracture (OR = 1.44; p = 0.013). Persistence of 1–6 months versus 19–24 months was associated with higher risk for any clinical (OR = 1.88, p < 0.001), vertebral (OR = 3.69; p < 0.001), and non-vertebral fracture (OR = 1.51; p = 0.011), but not hip (OR = 1.93; p = 0.08).
Conclusions
Fracture risk decreased as TPTD adherence and persistence increased for any clinical, vertebral, and non-vertebral fractures.
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Acknowledgments
We gratefully acknowledge the assistance of Johnna Anderson for statistical analysis for this manuscript. Funding for this work was provided by Eli Lilly and Company.
Conflicts of interest
Russel Burge, Shonda Foster, Steve Gelwicks, and Eric Meadows are employees and stockholders of Eli Lilly and Company. Shengsheng Yu’s research was funded under the Eli Lilly Global Health Outcomes Internship Program.
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Yu, S., Burge, R.T., Foster, S.A. et al. The impact of teriparatide adherence and persistence on fracture outcomes. Osteoporos Int 23, 1103–1113 (2012). https://doi.org/10.1007/s00198-011-1843-3
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DOI: https://doi.org/10.1007/s00198-011-1843-3