title: Anti-osteoporotic treatments in France: initiation, persistence and switches over 6 years of follow-up.
abstract: Limited information is available on anti-osteoporotic treatment initiation patterns in France. In 2006-2013, the most frequently prescribed first-line treatment class for osteoporosis was represented by bisphosphonates (alendronic acid and risedronic acid), followed by strontium ranelate. Persistence with anti-osteoporotic treatment was low, with high proportions of treatment discontinuations and switches.
  
  
  
  This epidemiological, longitudinal study described first-line treatment initiation, persistence, switches to second-line treatment, and medical care consumption in osteoporotic patients in France during the 2007-2013 period.
  
  
  
  Patients aged ≥50 years, who were recorded in a French claims database and did not die during the observation period, were included if they met ≥1 inclusion criteria for osteoporosis in 2007 (≥1 reimbursement for anti-osteoporotic treatment, hospitalisation for osteoporotic fracture (spine, hip, femur, forearm bones, humerus, wrist), or ≥1 reimbursement for long-term osteoporosis-associated status). We collected data on consumption of anti-osteoporotic treatment (alendronic acid, ibandronic acid, risedronic acid, zoledronic acid, raloxifene, strontium ranelate, teriparatide) and of osteoporosis-related medical care after the date of first reimbursement for anti-osteoporotic treatment.
  
  
  
  We obtained 2219 patients with a 6-year follow-up and 1387 who initiated an anti-osteoporotic treatment in 2007 and who can be selected for the treatment regimen analysis. The most frequently used first-line treatments were alendronic acid (32.7 %), risedronic acid (22.4 %), strontium ranelate (19.3 %), ibandronic acid (13.1 %) and raloxifene (12.2 %). Among patients who received these treatments, the highest persistence after 6 years was observed for raloxifene (37.3 %), alendronic acid (35.1 %) and risedronic acid (32.3 %). Treatment discontinuations were reported for 35.5 % (raloxifene) to 53.4 % (strontium ranelate) and treatment switches for 27.4 % (alendronic acid) to 56.6 % (ibandronic acid) of these patients.
  
  
  
  This study showed that persistence with anti-osteoporotic treatment was relatively low in France, with high proportions of treatment discontinuations and switches, and that patients with osteoporosis were insufficiently monitored by bone specialists.
authors.affiliation: Merck Sharp and Dohme, Paris, France. Manon.belhassen@univ-lyon1.fr.|PELyon, PharmacoEpidemiologie Lyon, Faculté d'Odontologie, 11 rue Guillaume Paradin, F-69372, Lyon, Cedex 08, France. Manon.belhassen@univ-lyon1.fr.|HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France. Manon.belhassen@univ-lyon1.fr.
authors.forename: M
authors.initials: M
authors.lastname: Belhassen
authors.affiliation: INSERM UMR 1033-University of Lyon, Rheumatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: C B
authors.initials: CB
authors.lastname: Confavreux
authors.affiliation: Department of Rheumatology and EA 4490, Lille University Hospital, Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Cortet
authors.affiliation: Merck Sharp and Dohme, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lamezec
authors.affiliation: PELyon, PharmacoEpidemiologie Lyon, Faculté d'Odontologie, 11 rue Guillaume Paradin, F-69372, Lyon, Cedex 08, France.|HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Ginoux
authors.affiliation: PELyon, PharmacoEpidemiologie Lyon, Faculté d'Odontologie, 11 rue Guillaume Paradin, F-69372, Lyon, Cedex 08, France.|HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France.|Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Van Ganse
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D057915:Drug Substitution / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: First-line treatment; France; Medical care; Osteoporosis; Persistence; Switch