title: The bone evaluation study (BEST): patient care and persistence to treatment of osteoporosis in Germany.
abstract: OBJECTIVE
  Data on fracture frequency and medical care of patients with osteoporosis are still insufficient. We aimed to analyze frequency of osteoporosis-related fractures and multiple fractures, re-fracture rates, treatment prevalence, and persistence to osteoporosis-related medication in Germany.
  
  
  METHODS
  Using claims data of a state health insurer (2006 - 2009), we performed a retrospective "real world" analysis. Inclusion criteria were age of 50 years or older and an osteoporosis diagnosis or a prescription for defined osteoporosis-related medication. We assessed fractures, frequencies, and the number of multiple fractures per patient as well as time to follow-up fracture and drug persistence using Kaplan-Meier analysis.
  
  
  RESULTS
  Within the observation period, 27% of the osteoporosis patients sustained fractures; of those with fractures, 69% had multiple fractures. For patients with multiple fractures, re-fracture rate after 360 days was between 69% for patients who received parathyroid hormone and 85% for patients who received no anti-osteoporotic medication 360 days before follow-up fracture. In the patient population, persistence rates after 1 year were between 58% for parathyroid hormone and 2% for other osteoporosis-specific drugs (alfacalcidol, fluorides, nandrolone, calcitonin).
  
  
  CONCLUSIONS
  In Germany, the number of patients with osteoporosis-attributable fractures is high. There are still deficits in proper treatment as well as in drug persistence. Low persistence lead to a relatively high proportion of patients with follow-up fractures.
authors.forename: Peyman
authors.initials: P
authors.lastname: Hadji
authors.forename: Silvia
authors.initials: S
authors.lastname: Klein
authors.forename: Bertram
authors.initials: B
authors.lastname: Häussler
authors.forename: Thomas
authors.initials: T
authors.lastname: Kless
authors.forename: Roland
authors.initials: R
authors.lastname: Linder
authors.forename: Maciej
authors.initials: M
authors.lastname: Rowinski-Jablokow
authors.forename: Frank
authors.initials: F
authors.lastname: Verheyen
authors.forename: Holger
authors.initials: H
authors.lastname: Gothe
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D005791:Patient Care; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents