title: Differences in persistency with teriparatide in patients with osteoporosis according to gender and health care provider.
abstract: This analysis investigated the persistence of teriparatide for treatment of osteoporosis in 829 patients according to gender and health care provider treated with teriparatide. This study showed that female patients were less persistent than males and those patients treated in the practices of orthopedic surgeons were more treatment persistent than patients treated in general practitioner (GP) practices.
  
  
  BACKGROUND
  The optimal persistency of teriparatide (TPTD) is of the upmost importance to ensure fracture risk reduction and pain relief. Data reporting on gender-specific or health care provider-dependent differences on health care provider-dependent persistence is currently lacking.
  
  
  METHODS
  We analyzed a large dataset extracted from the Disease Analyzer database (IMS Health, Germany). Out of a dataset of 15 million patients, we identified patients with osteoporosis who received first-time teriparatide prescriptions from January 2005 to December 2012.
  
  
  RESULTS
  All 829 patients (677 females and 152 males) were included in the study. The patients were treated by 214 general practitioners (GPs) and 143 orthopedic surgeons. After 18 months of follow-up, 39.5 % of the female and 34 % of the male patients discontinued their treatment (p = 0.0308). We found a significant difference in the discontinuation rate of patients treated by orthopedic surgeons (35.0 %) compared to patients treated by GPs (44.2 %) (p = 0.0445). Additionally, at the end of the 18 months of follow up, 39.4 % of female and 47.8 % of male patients were still on treatment. We found a highly significant decreased risk for treatment discontinuation in patients with fractures prior to treatment initiation compared to those without such fractures (hazard ratio (HR) 0.77; 95 % confidence interval (CI) 0.66-0.90). There was a significantly increased risk of treatment discontinuation for female patients (HR 1.38; 95 % CI 1.10-1.74) compared to male patients.
  
  
  CONCLUSIONS
  In conclusion, female patients presented higher discontinuation rates of TPTD compared to males. Patients treated in the practices of orthopedic surgeons were more persistent than patients treated in GP practices. TPTD persistence in patients with osteoporosis is higher than with antiresorptives but is still suboptimal and needs to be improved to ensure fracture risk reductions comparable to randomized controlled trial (RCT) results.
authors.affiliation: Department of Endocrinology, Reproductive Medicine and Osteoporosis, Philipps-University of Marburg, Baldingerstr. 1, 35043, Marburg, Germany, janniskyvernitakis@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Kyvernitakis
authors.forename: K
authors.initials: K
authors.lastname: Kostev
authors.forename: A
authors.initials: A
authors.lastname: Kurth
authors.forename: U S
authors.initials: US
authors.lastname: Albert
authors.forename: P
authors.initials: P
authors.lastname: Hadji
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods*; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010024:Osteoporosis / Q000188:drug therapy* / Q000523:psychology; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000523:psychology; D058866:Osteoporotic Fractures / Q000517:prevention & control; D012737:Sex Factors; D019379:Teriparatide / Q000627:therapeutic use*; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide