ORIGINAL ARTICLEAdherence to Bisphosphonate Therapy and Fracture Rates in Osteoporotic Women: Relationship to Vertebral and Nonvertebral Fractures From 2 US Claims Databases
Section snippets
Study Design
A retrospective cohort design was used to evaluate pharmacy and medical claims data. The study population was drawn from geographically diverse populations in the Medstat MarketScan Commercial Claims and Encounters and Medicare databases. Adjudicated claims from a 5-year period (January 1, 1999, through December 31, 2003), drawn from 45 employers and 100 health plans in the continental United States, were included in the analysis.
The Commercial Claims and Encounters database contains the health
Baseline Characteristics
The databases included 302,771 patients (Figure 1) who filled a bisphosphonate prescription between January 1, 1999, and December 31, 2003. Of these, 42,901 met theinclusion criteria, and 35,537 remained in the bisphosphonate cohort after exclusion criteria were applied. The mean patient age at the time the index prescription was filled was 65.3 years, and 59% of the women were between 55 and 74 years of age at index prescription (Table 1). Most women (85%; n=30,175) received an index
DISCUSSION
This retrospective analysis of a large population of bisphosphonate users followed up for 2 years demonstrated a significant association between adherence to bisphosphonate therapy and risk of osteoporotic fractures. Compared with patients who persisted with therapy, those with gaps in medication coverage had significantly more vertebral and nonvertebral fractures. Similar results were found when the records of those who were compliant and noncompliant were examined.
The current analyses were
CONCLUSIONS
The current study is among the largest observational studies to examine bisphosphonate therapy and fracture rates in osteoporotic women at least 45 years of age in the United States. This study also included 2 years of follow-up. Furthermore, the results contribute meaningful information by corroborating findings in earlier studies and extending them by examining site-specific fracture outcomes. Indeed, we observed a consistent and even greater reduction in fracture risk among compliant
Acknowledgments
We acknowledge Daniel R. Bretheim, MS, for his programming and database analysis; Gary Neidert, PhD, for his statistical contributions; and Ellen Lewis, PhD, and Stephanie Phillips, PhD, for their assistance with preparing the submitted manuscript.
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This study was supported and funded by F. Hoffmann-La Roche, Ltd, and GlaxoSmithKline.
Dr Siris has consulted for and received honoraria from Merck & Co, Inc, Eli Lilly, Novartis, Amgen Inc, Procter & Gamble, and sanofi-aventis, and she is on the speakers' bureau of Merck & Co, Inc, and Eli Lilly. Dr Harris has consulted for Amgen Inc, Eli Lilly, GlaxoSmithKline, Merck & Co, Inc, Novartis, Procter & Gamble, Roche Laboratories, Inc, sanofi-aventis, and Wyeth, and he is on the speakers' bureau of Eli Lilly, GlaxoSmithKline, Merck & Co, Inc, Procter & Gamble, Roche Laboratories, Inc, sanofi-aventis, and Wyeth. Dr Rosen has received research grants from sanofi-aventis, Eli Lilly, Merck, NPS Pharmaceuticals, and Wyeth. Dr Barr is an employee of Roche Laboratories, Inc. Dr Arvesen and his spouse have stocks in Merck & Co, Inc, and Procter & Gamble. Dr Abbott received financial support from Roche Laboratories, Inc, to conduct this study. Dr Silverman has received honoraria from the speakers' bureau and advisory board of Roche Laboratories, Inc.