title: Osteoporosis in the Women's Health Initiative: Another Treatment Gap?
abstract: Osteoporotic fractures are associated with high morbidity, mortality, and cost.
  
  
  
  We performed a post hoc analysis of the Women's Health Initiative (WHI) clinical trials data to assess osteoporosis treatment and identify participant characteristics associated with utilization of osteoporosis medication(s) after new diagnoses of osteoporosis or fracture. Information from visits prior to and immediately subsequent to the first fracture event or osteoporosis diagnosis were evaluated for medication use. A full logistic regression model was used to identify factors predictive of osteoporosis medication use after a fracture or a diagnosis of osteoporosis.
  
  
  
  The median length of follow-up from enrollment to the last WHI clinic visit for the study cohort was 13.9 years. Among the 13,990 women who reported new diagnoses of osteoporosis or fracture between enrollment and their final WHI visit, and also had medication data available, 21.6% reported taking an osteoporosis medication other than estrogen. Higher daily calcium intake, diagnosis of osteoporosis alone or both osteoporosis and fracture (compared with diagnosis of fracture alone), Asian or Pacific Islander race/ethnicity (compared with White/Caucasian), higher income, and hormone therapy use (past or present) were associated with significantly higher likelihood of osteoporosis pharmacotherapy. Women with Black/African American race/ethnicity (compared with White/Caucasian), body mass index ≥30 (compared with body mass index of 18.5-24.9), current tobacco use (compared with past use or lifetime nonusers), and history of arthritis were less likely to use osteoporosis treatment.
  
  
  
  Despite well-established treatment guidelines in postmenopausal women with osteoporosis or history of fractures, pharmacotherapy use was suboptimal in this study. Initiation of osteoporosis treatment after fragility fracture may represent an opportunity to improve later outcomes in these high-risk women. Specific attention needs to be paid to increasing treatment among women with fragility fractures, obesity, current tobacco use, history of arthritis, or of Black race/ethnicity.
authors.affiliation: University of Florida College of Medicine, Gainesville. Electronic address: maryam.sattari@medicine.ufl.edu.
authors.forename: Maryam
authors.initials: M
authors.lastname: Sattari
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Pa.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: University of Florida College of Medicine, Gainesville.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Garvan
authors.affiliation: University of Tennessee Health Science Center, Memphis.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: University at Buffalo, State University of New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaMonte
authors.affiliation: University of Massachusetts Medical School, Worcester.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: University of Florida College of Medicine, Gainesville.
authors.forename: Marian
authors.initials: M
authors.lastname: Limacher
authors.affiliation: University of Florida College of Medicine, Gainesville.
authors.forename: Todd
authors.initials: T
authors.lastname: Manini
authors.affiliation: School of Medicine and Public Health, University of Wisconsin-Madison.
authors.forename: Gloria E
authors.initials: GE
authors.lastname: Sarto
authors.affiliation: MedStar Washington Hospital Center, DC.
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Sullivan
authors.affiliation: University at Buffalo, State University of New York.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.affiliation: University of Florida College of Medicine, Gainesville; North Florida/South Georgia Geriatric Research, Education, and Clinical Center, Gainesville, Fla.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use*; D004522:Educational Status; D005260:Female; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014807:Vitamin D / Q000627:therapeutic use*; D016387:Women's Health / Q000706:statistics & numerical data
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium
keywords: Disparity; Fracture; Osteoporosis; Treatment