Top

Osteoporosis International

Published in:

Open Access 01-03-2017 | Original Article

Hip and other fragility fracture incidence in real-world teriparatide-treated patients in the United States

Authors: R. T. Burge, D. P. Disch, S. Gelwicks, X. Zhang, J. H. Krege

Published in: Osteoporosis International | Issue 3/2017

Abstract

Summary

This study demonstrates real-world effectiveness of teriparatide in reducing the risk of hip and other fragility fractures. Fracture incidence significantly decreased as adherence and persistence increased for any clinical, vertebral, nonvertebral, and hip fractures among patients who were observed for 2 years after teriparatide initiation.

Introduction

Examine the relationship of treatment adherence and persistence to teriparatide with hip and other fractures.

Methods

Truven MarketScan Research Databases, 2004 through 2014, provided teriparatide users ≥18 years old with continuous coverage 12 months pre- and 24 months post-teriparatide prescription. Adherence (medication possession ratio, MPR) groups were defined as high (≥0.80), medium (0.50 ≤ MPR < 0.80), and low (<0.50). Persistence, allowing for ≤90-day gaps between prescriptions, was defined as 1–6, 7–12, 13–18, and 19–24 months. Fracture incidence was summarized and compared by using ANOVA and logistic regression models; the effects of adherence were examined with Cox proportional hazard models with time-dependent covariates for teriparatide exposure.

Results

Among 14,284 teriparatide subjects, mean age was 68.4 years, 89.8% were female, and 29.6% had a fracture in the previous year; these characteristics were similar across MPR and persistence groups. The effects of adherence and persistence to teriparatide were statistically significant (P < .001) for all fracture types except wrist (P ≥ .125). By logistic regression, high vs low adherence was associated with reduced risk for any (OR = 0.67; P < .001); vertebral (OR = 0.64; P < .001); nonvertebral (OR = 0.71; P < .001); and hip fractures (OR = 0.52; P < .001) and longer (19–24 months) vs shorter persistence (1–6 months) was associated with reduced risk for any (OR = 0.63, P < .001); vertebral (OR = 0.56, P < .001); nonvertebral (OR = 0.69, P < .001); and hip fractures (OR = 0.48, P < .001). Cox models revealed a significantly reduced risk between high and low adherence for any (OR = 0.69, P < .001); vertebral (OR = 0.60, P < .001); nonvertebral (OR = 0.77, P < .001); and hip fractures (OR = 0.55, P < .001).

Conclusion

Fracture incidence significantly decreased as persistence and adherence to teriparatide increased.

Available only for authorised users

National Osteoporosis Foundation. What is osteoporosis? https://www.nof.org/patients/what-is-osteoporosis/. Accessed 18 May 2016

National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation; 2013

Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States. J Bone Miner Res 22(3):465–475CrossRefPubMed

Melton LJ 3rd, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9(1):29–37CrossRefPubMed

Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579CrossRefPubMedPubMedCentral

Leslie WD, O’Donnell S, Jean S, Lagacé C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Trends in hip fracture rates in Canada. JAMA 302(8):883–889CrossRefPubMed

Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jävinen M (2006) Nationwide decline in incidence of hip fractures. J Bone Miner Res 21(12):1836–1838CrossRefPubMed

Nymark T, Lauritsen JM, Ovesen O, Röck ND, Jeune B (2006) Decreasing incidence of hip fracture in the Funen County, Denmark. Acta Orthop 77(1):109–113CrossRefPubMed

Dimai HP, Svedbom A, Fahrleitner-Pammer A, Pieber T, Resch H, Zwettler E, Chandran M, Borgström F (2010) Epidemiology of hip fractures in Austria: evidence for a change in the secular trend. Osteoporos Int 22(2):685–692CrossRefPubMed

10.

Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 45(3):M101–M107CrossRefPubMed

11.

Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55(9):M498–M507CrossRefPubMed

12.

van Staa TP, Leufkens HGM, Cooper C (2002) Does fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13(8):624–629CrossRefPubMed

13.

Binder EF, Brown M, Sinacore DR, Steger-May K, Yarasheski KE, Schechtman KB (2004) Effects of extended outpatient rehabilitation after hip fracture. A randomized controlled trial. JAMA 292(7):837–846CrossRefPubMed

14.

Bhandari M, Tornetta P 3rd, Hanson B, Swiontkowski MF (2009) Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws. J Orthop Trauma 23:403–407CrossRefPubMed

15.

Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344(19):1434–1441CrossRefPubMed

16.

Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A, Kaufman JM, Clancy AD, Gaich GA (2003) The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis. J Bone Miner Res 18(1):9–17CrossRefPubMed

17.

Keaveny TM, Donley DW, Hoffmann PF, Mitlak BH, Glass EV, San Martin JA (2007) Effects of teriparatide and alendronate on vertebral strength as assessed by finite element modeling of QCT scans in women with osteoporosis. J Bone Miner Res 21:149–157

18.

Forteo [package insert]. Indianapolis, IN: Eli Lilly and Company; 2010

19.

Forsteo [Summary of Product Characteristics]. Eli Lilly Nederland B.V. 2010

20.

Lindsay R, Miller P, Pohl G, Glass EV, Chen P, Krege JH (2009) Relationship between duration of teriparatide therapy and clinical outcomes in postmenopausal women with osteoporosis. Osteoporos Int 20(6):943–948CrossRefPubMed

21.

Langdahl BL, Rajzbaum G, Jakob F, Karras D, Ljunggren Ö, Lems WF, Fahrleitner-Pammer A, Walsh JB, Barker C, Kutahov A, Marin F (2009) Reduction in fracture rate and back pain and increased quality of life in postmenopausal women treated with teriparatide: 18-month data from the European Forsteo Observational Study (EFOS). Calcif Tissue Int 85(6):484–493CrossRefPubMedPubMedCentral

22.

Silverman S, Miller P, Sebba A, Weitz M, Wan X, Alam J, Mascia D, Taylor KA, Ruff VA, Krohn K (2013) The direct assessment of nonvertebral fractures in community experience (DANCE) study: 2-year nonvertebral fragility fracture results. Osteoporos Int 24(8):2309–2317CrossRefPubMedPubMedCentral

23.

Yu S, Burge RT, Foster S, Gelwicks S, Meadows E (2012) The impact of teriparatide adherence and persistence on fracture outcomes. Osteoporos Int 23(3):1102–1113CrossRef

24.

Seeman E, Compston J, Adachi J, Brandi ML, Cooper C, Dawson-Hughes B, Jönsson B, Pols H, Cramer JA (2007) Non-compliance: the Achilles’ heel of anti-fracture efficacy. Osteoporos Int 18(6):711–719CrossRefPubMed

25.

Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81(8):1013–1022CrossRefPubMed

26.

Siris E, Selby P, Saag KG, Borgström F, Herings R, Silverman SL (2009) Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 122(2 Suppl):S3–S13CrossRefPubMed

27.

Penning-van Beest FJ, Erkens JA, Olson M, Herings RM (2008) Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int 19(4):511–517CrossRefPubMed

28.

Weycker D, Macarios D, Edelsberg J, Oster G (2007) Compliance with osteoporosis drug therapy and risk of fracture. Osteoporos Int 18(3):271–277CrossRefPubMed

29.

Halpern R, Becker L, Iqbal SU, Kazis LE, Macarios D, Badamgarav E (2011) The association of adherence to osteoporosis therapies with fracture, all-cause medical costs, and all-cause hospitalizations: a retrospective claims analysis of female health plan enrollees with osteoporosis. J Manag Care Pharm 17(1):25–39PubMed

30.

Cheng LI, Durden E, Limone B, Radbill L, Juneau PL, Spangler L, Mirza FM, Stolshek BS (2015) Persistance and compliance with osteroporosis therapies among women in a commercially insured population in the United States. J Manag Care Spec Pharm 21(9):824–833CrossRefPubMed

31.

Foster SA, Foley KA, Meadows ES, Johnston JA, Wang SS, Pohl GM, Long SR (2011) Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance. Osteoporos Int 22(2):551–557CrossRefPubMed

32.

Chan DC, Chang CH, Lim LC, Brnabic AJ, Tsauo JY, Burge R, Hsiao FY, Jin L, Gürbiüz S, Yang RS (2016) Association between teriparatide treatment duration and fracture incidence in Taiwan: analysis using the National Health Insurance Research Database. Osteoporosis Int. doi:10.1007/s00198-016-3611-x CrossRef

33.

Boytsov N, Zhang X, Sugihara T, Taylor K, Swindle R (2015) Osteoporotic fractures and associated hospitalizations among patients treated with teriparatide compared to a matched cohort of patients not treated with teriparatide. Curr Med Res Opin 31(9):1665–1675CrossRefPubMed

34.

Bonafede MM, Shi N, Bower AG, Barron RL, Grauer A, Chandler DB (2015) Teriparatide treatment patterns in osteoporosis and subsequent fracture events: a US claims analysis. Osteoporos Int 26(3):1203–1212CrossRefPubMedPubMedCentral

35.

Krege JH, Burge RT, Marin F (2015) Teriparatide fracture effectiveness in the real world. Osteoporos Int 26(8):2217–2218CrossRefPubMed

36.

Lee RH, Lyles KW, Colon-Emerec C (2010) A review of the effect of anticonvulsant medications on bone mineral density and fracture risk. J Am Ger Soc 8(1):34–46

37.

Petty SJ, O'Brien TJ, Wark JD (2007) Anti-epileptic medication and bone health. Osteoporos Int 18(2):129–142CrossRefPubMed

38.

Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, Saag K (2011) Which fractures are most attributable to osteoporosis? J Clin Epidemiol 64(1):46–53CrossRefPubMedPubMedCentral

39.

Curtis JR, Yun H, Lange JL, Matthews R, Sharma P, Saag KG, Delzell E (2012) Does medication adherence itself confer fracture protection? An investigation of the healthy adherer effect in observational data. Arthritis Care Res 64(12):1855–1863. doi:10.1002/acr.21759 CrossRef

40.

Patrick AR, Shrank WH, Glynn RJ, Solomon DH, Dormuth CR, Avorn J, Cadarette SM, Mogun H, Brookhar MA (2011) The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults. Value Health 14:513–520CrossRefPubMedPubMedCentral

41.

Eriksen E, Keaveny TM, Gallagher ER, Krege JH (2014) Literature review: the effects of teriparatide at the hip in patients with osteoporosis. Bone 67:246–256CrossRefPubMed

42.

Hopkins RB, Goeree R, Pullenayegum E, Adachi JD, Papaioannou A, Xie F, Thabane L (2011) The relative efficacy of nine osteoporosis medications for reducing the rate of fractures in post-menopausal women. BMC Musculoskelet Disord 12:209CrossRefPubMedPubMedCentral

43.

Cadarette SM, Solomon DH, Katz JN, Patrick AR, Brookhart MA (2011) Adherence to osteoporosis drugs and fracture prevention: no evidence of healthy aderer bias in a frail cohort of seniors. Osteoporos Int 22:943–954CrossRefPubMed

44.

Curtis JR, Mudano AS, Solomon DH, Xi J, Melton ME, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47(1):69–72CrossRefPubMedPubMedCentral

45.

Cosman F, Dempster DW, Nieves JW, Zhou H, Zion M, Roimisher C, Houle Y, Lindsay R, Bostrom M (2016) Effect of teriparatide on bone formation in the human femoral neck. J Clin Endocrinol Metab 101(4):1498–1505CrossRefPubMedPubMedCentral

Title: Hip and other fragility fracture incidence in real-world teriparatide-treated patients in the United States
Authors: R. T. Burge
D. P. Disch
S. Gelwicks
X. Zhang
J. H. Krege
Publication date: 01-03-2017
Publisher: Springer London
Published in: Osteoporosis International / Issue 3/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-016-3888-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hip and other fragility fracture incidence in real-world teriparatide-treated patients in the United States

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2017

Celiac disease is associated with reduced bone mineral density and increased FRAX scores in the US National Health and Nutrition Examination Survey

High mortality in younger patients with major osteoporotic fractures

Optimum dose of vitamin D for disease prevention in older people: BEST-D trial of vitamin D in primary care

Teriparatide treatment in a heart transplant patient with a chronic kidney disease and a low-turnover bone disease: a case report

Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study

Vertebral fracture assessment by dual X-ray absorptiometry