title: Reasons for not initiating osteoporosis therapy among a managed care population.
abstract: BACKGROUND
  Many women with osteoporosis do not initiate osteoporosis treatment.
  
  
  OBJECTIVE
  To examine patients' reasons for not initiating osteoporosis treatment among women with osteoporosis.
  
  
  METHODS
  Survey recipients were identified from a national US claims database and included women ≥55 years with an osteoporosis diagnosis from January 1, 2010 to March 31, 2012 as defined by: 1) osteoporosis diagnosis coupled with bone mineral density test within 183 days of diagnosis and/or 2) osteoporosis-related fracture. Eligibility required no claims for osteoporosis medication 1) at least 12 months and up to 5 years prior to osteoporosis diagnosis and 2) at least 6 months after osteoporosis diagnosis. Continuous enrollment for 18 months (6 months pre-osteoporosis and 12 months post-osteoporosis diagnosis) was also required. A total of 2,000 patients with the most recent osteoporosis diagnosis were mailed a survey. Respondents reporting that they did not initiate physician-recommended osteoporosis medication, after either their physician told them they had osteoporosis or they experienced a fracture since age 45 years, were asked for reasons why they did not initiate treatment.
  
  
  RESULTS
  There were 430 patients who returned a complete survey; mean age was 61% and 21.6% had a fracture. A total of 197 (45.8%) patients reported their physician diagnosed osteoporosis and 117 (59.3%) of those were recommended osteoporosis medication; 44 of the 117 patients (37.6%) did not initiate recommended osteoporosis medication by the time of survey. The primary reasons for not initiating osteoporosis medication were concern over side effects (77.3%), medication costs (34.1%), and pre-existing gastrointestinal concerns (25.0%).
  
  
  CONCLUSIONS
  Among respondents, 41% of patients whose physician diagnosed osteoporosis were not recommended osteoporosis treatment and 38% of patients who were recommended osteoporosis treatment did not initiate treatment within approximately 2 years of diagnosis. Concerns with side effects of osteoporosis treatment, medication costs, and pre-existing gastrointestinal concerns were the most common reasons for not initiating recommended treatment.
authors.affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Yu
authors.affiliation: Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Brenneman
authors.affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Vasilisa
authors.initials: V
authors.lastname: Sazonov
authors.affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Ankita
authors.initials: A
authors.lastname: Modi
keywords: bisphosphonate; patient survey; primary nonadherence; treatment initiation