Elderly Men May Be Undertreated for Osteoporosis

Elderly men were significantly undertreated for osteoporosis compared with elderly women, and this was particularly prominent among black patients, according to study data published in The Journal of Pharmaceutical Health Services Research.

Investigators conducted a cross-sectional analysis of elderly (≥70 years) beneficiaries with osteoporosis drawn from a random 5% sample of the Medicare population. Individuals selected for inclusion were each enrolled in Part A, B, and Part D stand-alone prescription drug plans from January 1, 2006, through December 31, 2008. From Medicare claims, investigators abstracted demographic characteristics, conditions and medications contributing to osteoporosis, bone fracture or falls, and contraindications or side effects of osteoporosis medications claims. Prescription drugs used to treat osteoporosis included bisphosphonates, calcitonin, parathyroid hormone analog, and selective estrogen receptor modulator.

The study sample comprised 8465 men and 90,956 women with osteoporosis. The prevalence of osteoporosis medication use was significantly greater in women than in men in 2006 (44.3% vs 25.2%) and 2008 (42.0% vs 24.5%). Results of stratified analyses conducted after interaction terms between sex and age, race, and residential status were found to be statistically significant. With increasing age, men were more likely to be treated than women, although women received more treatment overall. Specifically, the probability of an elderly man with osteoporosis receiving treatment was just 20% of that in women. Black men (relative risk, 0.76; 95% CI, 0.68-0.85) and black women (RR, 0.61; 95% CI, 0.59-0.63) were significantly less likely to receive osteoporosis treatment compared with white men and white women.

Patients who received bone marrow density testing were more likely to receive pharmaceutical treatment, although the association was much stronger in men than in women (P <.05). Bisphosphonates were the most commonly used pharmaceutical treatment for all participants, although nonbisphosphonate use increased with advancing age.

These data highlight the undertreatment of osteoporosis among elderly men and elderly black patients. Clinicians should expand the focus of treatment initiatives to include these underserved populations.

Reference

Loh F-HE, Stuart B, Davidoff A, Sturpe D, Onukwugha E, Hochberg M. Differences in evidence‐based osteoporosis medication use between elderly men and women enrolled in Medicare Part D [published online March 5, 2019]. J Pharm Health Serv Res. doi:10.1111/jphs.12291