MEDICATIONS: NEWER OSTEOPOROSIS DRUGS ASSOCIATED WITH INCREASED PATIENT VISITS AND TREATMENT

July 26, 2004 — New medications for osteoporosis, offering improved efficacy and convenient dosing, are associated with increased frequency of patient visits and treatment. The finding suggests new drug therapy contributes to increased disease recognition and treatment, according to an article in the July 26 issue of The Archives of Internal Medicine, a journal of the American Medical Association.

According to background information in the article, osteoporosis is a condition of low bone mass and deterioration of bone microarchitecture, leading to increased susceptibility to fracture and painful disease. Osteoporosis is determined clinically by bone mineral density (BMD) testing; its prevalence in the United States was approximately 10 percent in 2000, using the World Health Organization definition of low BMD. Research on physicians' prescribing practices for osteoporosis treatment is limited.

Randall S. Stafford, M.D., Ph.D., and colleagues from the Stanford Prevention Research Center, Stanford University in Palo Alto, Calif., tracked trends from 1988 to 2003 in the frequency of osteoporosis visits and patterns of pharmacotherapy associated with these visits. The authors used nationally representative data on prescribing patterns of office-based U.S. physicians from the IMS HEALTH National Disease and Therapeutic Index.

"The number of physician visits for osteoporosis increased four-fold between 1994 (1.3 million visits) and 2003 (6.3 million visits), whereas it had remained stable in prior years," the authors report. "This increase coincided with the availability of oral daily bisphosphonates and the selective estrogen receptor modulator raloxifene." Bisphosphonates and the selective estrogen receptor modulator raloxifene are drugs used to both prevent and treat osteoporosis.

"The annualized percentage of osteoporosis visits where medications were prescribed increased from 82 percent in 1988 to 97 percent by 2003," the authors write.

Prior to 1994, the leading choices for osteoporosis therapy were calcium and estrogens, with lesser roles played by bisphosphonates and calcitonins (drugs made up of a naturally occurring hormone involved in calcium regulation and bone metabolism). "Between 1994 and 2003, the percentage of visits where bisphosphonates and raloxifene were prescribed increased from 14 percent to 73 percent and from 0 percent to 12 percent, respectively, while prescriptions for other medications declined," the authors report.

"Treatment of osteoporosis has improved in recent years in association with the availability of new medications. Physicians are prescribing drugs with greater effectiveness and convenience, and recognition of osteoporosis is increasing," they write.

"The future role of estrogens in osteoporosis treatment and prevention is uncertain despite their effectiveness in preventing osteoporotic fractures. As estrogens are no longer recommended for long-term use in postmenopausal women, greater attention to osteoporosis prevention is critical," the authors conclude. "This includes calcium use and physical activity as well as potential advancements in pharmacotherapy for osteoporosis prevention."