title: Osteoporotic fractures and associated hospitalizations among patients treated with teriparatide compared to a matched cohort of patients not treated with teriparatide.
abstract: OBJECTIVE
  To compare fractures and fracture-related resource utilization (RU) among patients with a recent fracture and treated with teriparatide (TPTD) to a matched cohort of patients not treated with TPTD (non-TPTD).
  
  
  METHODS
  Women aged 50 years or older initiating TPTD (N = 5314; index date between 1 January 2007 and 31 December 2012) were identified in an insurance claims database. Patients with fragility fracture (hip, pelvis, clavicle, humerus, wrist, leg or spine) during the 12 months prior to the index date (N = 1164) were selected to control for unmeasured confounding due to absence of bone mineral density test levels. TPTD patients were matched to the non-TPTD cohort using propensity score and exact matching (N = 912). Relative risk (RR) of fracture and fracture-related RU were estimated by Cox proportional hazard modeling, adjusted for potential fracture risk factors.
  
  
  RESULTS
  Fractures were observed in 4.6%, 8.6%, 10.3%, and 11.3% of TPTD patients and in 9.2%, 15.2%, 19.2% and 21.7% of non-TPTD patients over 6, 12, 18, and 24 months, respectively. The adjusted RR reduction in TPTD was 36% (RR = 0.64, 95% CI: 0.44-0.94) during 6 months, 27% (RR = 0.73, 95% CI: 0.54-0.97) during 12 months, 28% (RR = 0.72, 95% CI: 0.55-0.93) during 18 months, and 28% (RR = 0.72, 95% CI: 0.56-0.92) during 24 months versus matched non-TPTD patients. Fracture-related RU followed a similar trend to that observed for fracture risk.
  
  
  CONCLUSIONS
  This real-world study found TPTD to be more effective in reducing risk of fragility fractures as early as 6 months with continuous treatment benefit up to 24 months compared to a matched non-TPTD cohort. TPTD patients experienced lower rates of fracture-related RU than non-TPTD patients. Key study limitations include the inability to confirm reported diagnostic and procedural codes and the absence of uninsured and individually insured patients in the claims database.
authors.affiliation: a a Eli Lilly and Company , Indianapolis , IN , USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Boytsov
authors.affiliation: a a Eli Lilly and Company , Indianapolis , IN , USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhang
authors.affiliation: b b inVentiv Health Clinical , Princeton , NJ , USA.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sugihara
authors.affiliation: a a Eli Lilly and Company , Indianapolis , IN , USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Taylor
authors.affiliation: a a Eli Lilly and Company , Indianapolis , IN , USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Swindle
mesh_terms: D000368:Aged; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D019379:Teriparatide / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide
keywords: Comparative effectiveness; Healthcare resource utilization; Osteoporosis; Teriparatide