title: Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage.
abstract: OBJECTIVE
  To examine the rate of osteoporosis (OP) undertreatment and the association between gastrointestinal (GI) events and OP treatment initiation among elderly osteoporotic women with Medicare Part D drug coverage.
  
  
  METHODS
  This retrospective cohort study utilized a 20% random sample of Medicare beneficiaries. Included were women ≥66 years old with Medicare Part D drug coverage, newly diagnosed with OP in 2007-2008 (first diagnosis date as the index date), and with no prior OP treatment. GI event was defined as a diagnosis or procedure for a GI condition between OP diagnosis and treatment initiation or at the end of a 12-month follow-up, whichever occurred first. OP treatment initiation was defined as the use of any bisphosphonate (BIS) or non-BIS within 1 year postindex. Logistic regression, adjusted for patient characteristics, was used to model the association between 1) GI events and OP treatment initiation (treated versus nontreated); and 2) GI events and type of initial therapy (BIS versus non-BIS) among treated patients only.
  
  
  RESULTS
  A total of 126,188 women met the inclusion criteria: 72.1% did not receive OP medication within 1 year of diagnosis and 27.9% had GI events. Patients with a GI event were 75.7% less likely to start OP treatment (odds ratio [OR]=0.243; P<0.001); among treated patients, patients with a GI event had 11.3% lower odds of starting with BIS versus non-BIS (OR=0.887; P<0.001).
  
  
  CONCLUSIONS
  Among elderly women newly diagnosed with OP, only 28% initiated OP treatment. GI events were associated with a higher likelihood of not being treated and, among treated patients, a lower likelihood of being treated with BIS versus non-BIS.
authors.affiliation: Toni Stabile Osteoporosis Center, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA.
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Siris
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Yu
authors.affiliation: Precision Health Economics, Los Angeles, CA, USA.
authors.forename: Katalin
authors.initials: K
authors.lastname: Bognar
authors.affiliation: Real-World Evidence Solutions, IMS Health, Fairfax, VA, USA.
authors.forename: Mitch
authors.initials: M
authors.lastname: DeKoven
authors.affiliation: Precision Health Economics, Los Angeles, CA, USA.
authors.forename: Anshu
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Romley
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Ankita
authors.initials: A
authors.lastname: Modi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D054524:Medicare Part D / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D050071:Bone Density Conservation Agents
keywords: gastrointestinal; osteoporosis; postmenopausal women; treatment initiation