Clinical Management of Women with Newly Diagnosed Osteoporosis: Data from Everyday Practice in Bulgaria

• Published in: Rheumatology and therapy. Vol. 8; no. 4; pp. 1477 - 1491
• Main Authors: Boyanov, Mihail A., Borissova, Anna-Maria, Petranova, Tzvetanka P., Popivanov, Plamen R., Stoilov, Rumen M., Petkova, Reneta T.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-12-2021; Springer Nature B.V
• Subjects: Clinical medicine; Family Medicine; General Practice; Internal Medicine; Medicine; Medicine & Public Health; Orthopedics; Osteoporosis; Quality of Life Research; Review; Rheumatology; Osteoporosis treatment; Primary/secondary care physicians; Duration
• ISSN: 2198-6576; 2198-6584
• DOI: 10.1007/s40744-021-00358-0

Introduction
The real duration of osteoporosis treatment in clinical practice is still not well described. The primary objective is to estimate the proportion of patients who stayed on treatment during a 4-year follow-up, and the secondary objective is to estimate the proportion of patients who switched treatment and the reasons for switch or discontinuation.
Methods
This was a national retrospective chart review, based on routine clinical data. Data were collected electronically from medical records in 33 representative primary care physicians’ sites. Inclusion criteria were women with postmenopausal osteoporosis that have received initial treatment prescription following diagnosis by DXA between January 1, 2012 and December 31, 2014, and at least a 12-month database history after the index date. Exclusion criteria were women receiving treatment for osteoporosis and follow-up at secondary care physicians’ sites only. All statistical analyses were performed with the R statistical package.
Results
A total of 1206 female patients with newly diagnosed osteoporosis and treatment initiation were followed for 4 years. The majority (88.3%) had no history of previous fractures. Bone mineral density data were available in 70.1%. Endocrinology was the most common specialty among prescribing specialists (40.0%), followed by rheumatology (30.3%). Bisphosphonates (BPs) were the most common initial treatment (72.7%), followed by denosumab (20.1%). Ibandronate (70.2%) and alendronate (24.2%) constituted the majority of all prescribed BPs; 731 patients remained on treatment during the second year (60.6%), 524 during the third year (43.4%) and 403 (33.4%)—at study end (fourth year). In all groups, except that on denosumab, the most common reason for switching to another treatment was presumed lack of effect. The main reasons for treatment discontinuation were financial on the patient’s part.
Conclusions
The duration of osteoporosis treatment in real-world clinical practice is far from optimal: < 3–4 years irrespective of fracture risk. Factors other than medical considerations are at play, mainly limitations set by the Health Insurance Fund. The health authorities should be aware of this.