Real-World Osteoporosis Drug Utilization in Patients with Recurrent Osteoporotic Fracture: A Nationwide Cohort Study in South Korea

OBJECTIVES: This study aims to investigate the real-world utilization of osteoporosis medication among patients who experienced recurrent osteoporotic fractures (OF). Given the heightened risk of subsequent fractures in this population and the imperative for more effective osteoporosis management in line with treatment guidelines, there is distinct need to establish the real-world evidence of osteoporosis medication.

METHODS: We conducted a longitudinal retrospective cohort study utilizing the Health Insurance Review and Assessment database from 2012 to 2021, encompassing Korea’s entire population. Our study focused on patients aged 55 years or older who experienced the first recurrent OF within two years after their primary OF diagnosis in 2013, excluding those with cancer, Paget's disease or other bone diseases unrelated to osteoporosis, or death during the study-period. One year of washout period was used to define primary OF diagnosis. Outcomes of interest were the proportion, duration, and discontinuation rates of osteoporosis medication during two years of follow-up from the date of the first recurrent OF.

RESULTS: A total of 34,558 patients with the first recurrent OF were observed. Of these patients, 18,462 (53.42%) received any osteoporosis medication. The proportion of medication was significantly higher among the elderly compared to the younger population. The median time on osteoporosis drug utilization, which included selective estrogen receptor modulators, bisphosphonates, and teriparatide, was 146 days (interquartile range: 61-365 days). The discontinuation rate of OF medications within two years of follow-up was 80.50%, with the highest discontinuation rate of 90.36% observed among patients taking daily oral bisphosphonates.

CONCLUSIONS: Although patients with recurrent fractures require intensive osteoporosis management, our results revealed a significant suboptimal utilization off osteoporosis drugs among them. Therefore, it is crucial to establish strategic treatment guidelines and reimbursement criteria to fill the gaps in the unmet need for osteoporosis treatment among very high-risk patients with recurrent OFs.