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Trends in Drug Prescribing for Osteoporosis After Hip Fracture, 1995-2004
SUZANNE M. CADARETTE, JEFFREY N. KATZ, M. ALAN BROOKHART, RAISA LEVIN, MARGARET R. STEDMAN, NITEESH K. CHOUDHRY, and DANIEL H. SOLOMON
ABSTRACT. Methods. We conducted a population-based study of enrollees in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly. Hip fractures were identified using Medicare hospital claims between January 1, 1995, and June 30, 2004. Osteoporosis treatment comprised oral bisphosphonates, calcitonin, hormone therapy, raloxifene, and/or teriparatide. Kaplan-Meier methods were used to estimate the probability of treatment within 6 months of fracture, censoring patients on their date of death or 6 months postfracture. Results. Treatment within 6 months after hip fracture improved from 7% in 1995 to 31% in 2002, and then remained stable through 2004. Similar patterns were observed among new users, with treatment increasing from 4% in 1995 to 17% in 2002, with no subsequent increase through 2004. Bisphosphonates led other treatments in the frequency of prescribing, except during 1997-99, when calcitonin was the most common. Among women, hormone therapy prescribing decreased from 22% of those treated in 1995 to 4% in 2004, and raloxifene prescribing remained relatively constant (4%–10%) since its introduction (p for trend = 0.15). Of patients treated before and after hip fracture, 18% changed therapy postfracture. Significantly more patients changed therapy following fracture if a different physician prescribed treatment (26%) compared to those treated by the same physician pre- and postfracture (13%; p < 0.0001). Conclusion. Prescribing practices changed substantially over the 10 years of study. The proportion of hip fracture patients treated with osteoporosis drugs has increased, but remains low, with fewer than one-third receiving pharmacotherapy. (First Release Dec 1 2007; J Rheumatol 2008;35:319-26) Key Indexing Terms:
HIP FRACTURES
From the Division of Pharmacoepidemiology and Pharmacoeconomics and Division of Rheumatology, Immunology and Allergy and the Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Dr. Brookhart is supported by the National Institute on Aging (K25 AG027400); Dr. Cadarette is supported by the Canadian Institutes of Health Research (Post-Doctoral Fellowship); Dr. Katz is supported by the National Institutes of Health/National Institute of Arthritis and Muskuloskeletal and Skin Diseases (K24 AR02123 and P60 AR47782); Dr. Solomon is supported by grants from the Arthritis Foundation and the National Institutes of Health (R21 AG027066 and P60 AR47782). Coauthors have received salary support from research grants to the Brigham and Women's Hospital for unrelated work from Amgen (Dr. Brookhart), GlaxoSmithKline (Dr. Choudhry), Merck (Dr. Solomon), Novartis (Dr. Katz), Pfizer, Procter & Gamble, and Savient (Dr. Solomon). S.M. Cadarette, PhD, Divisions of Pharmacoepidemiology and Pharmacoeconomics and Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; J.N. Katz, MD, MS, Division of Rheumatology, Immunology and Allergy and Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School; M.A. Brookhart, PhD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; R. Levin, MS, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; M.R. Stedman, MS, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School and Department of Biostatistics, Boston University; N.K. Choudhry, MD, PhD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School; D.H. Solomon, MD, MPH, Divisions of Pharmacoepidemiology and Pharmacoeconomics and Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School. Address reprint requests to Dr. S.M. Cadarette, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120. E-mail: s.cadarette@utoronto.ca. Accepted for publication September 17, 2007. |
