Osteoporosis in the Women's Health Initiative

Another Treatment Gap?

Maryam Sattari, Jane A. Cauley, Cynthia Garvan, Karen Johnson, Michael J. LaMonte, Wenjun Li, Marian Limacher, Todd Manini, Gloria E. Sarto, Shannon D. Sullivan, Jean Wactawski-Wende, Rebecca J. Beyth

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Abstract

Background Osteoporotic fractures are associated with high morbidity, mortality, and cost. Methods 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. Results 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)937-948
Number of pages12
JournalAmerican Journal of Medicine
Volume130
Issue number8
DOIs
StatePublished - Aug 1 2017

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Women's Health
Osteoporosis
Therapeutics
Tobacco Use
Arthritis
Body Mass Index
Logistic Models
Drug Therapy
Osteoporotic Fractures
Ambulatory Care
African Americans
Estrogens
Cohort Studies
Obesity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Sattari, M., Cauley, J. A., Garvan, C., Johnson, K., LaMonte, M. J., Li, W., ... Beyth, R. J. (2017). Osteoporosis in the Women's Health Initiative: Another Treatment Gap? American Journal of Medicine, 130(8), 937-948. https://doi.org/10.1016/j.amjmed.2017.02.042

Osteoporosis in the Women's Health Initiative : Another Treatment Gap? / Sattari, Maryam; Cauley, Jane A.; Garvan, Cynthia; Johnson, Karen; LaMonte, Michael J.; Li, Wenjun; Limacher, Marian; Manini, Todd; Sarto, Gloria E.; Sullivan, Shannon D.; Wactawski-Wende, Jean; Beyth, Rebecca J.

In: American Journal of Medicine, Vol. 130, No. 8, 01.08.2017, p. 937-948.

Research output: Contribution to journalArticle

Sattari, M, Cauley, JA, Garvan, C, Johnson, K, LaMonte, MJ, Li, W, Limacher, M, Manini, T, Sarto, GE, Sullivan, SD, Wactawski-Wende, J & Beyth, RJ 2017, 'Osteoporosis in the Women's Health Initiative: Another Treatment Gap?', American Journal of Medicine, vol. 130, no. 8, pp. 937-948. https://doi.org/10.1016/j.amjmed.2017.02.042
Sattari, Maryam ; Cauley, Jane A. ; Garvan, Cynthia ; Johnson, Karen ; LaMonte, Michael J. ; Li, Wenjun ; Limacher, Marian ; Manini, Todd ; Sarto, Gloria E. ; Sullivan, Shannon D. ; Wactawski-Wende, Jean ; Beyth, Rebecca J. / Osteoporosis in the Women's Health Initiative : Another Treatment Gap?. In: American Journal of Medicine. 2017 ; Vol. 130, No. 8. pp. 937-948.
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abstract = "Background Osteoporotic fractures are associated with high morbidity, mortality, and cost. Methods 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. Results 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. Conclusion 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.",
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AU - Garvan, Cynthia

AU - Johnson, Karen

AU - LaMonte, Michael J.

AU - Li, Wenjun

AU - Limacher, Marian

AU - Manini, Todd

AU - Sarto, Gloria E.

AU - Sullivan, Shannon D.

AU - Wactawski-Wende, Jean

AU - Beyth, Rebecca J.

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N2 - Background Osteoporotic fractures are associated with high morbidity, mortality, and cost. Methods 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. Results 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. Conclusion 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.

AB - Background Osteoporotic fractures are associated with high morbidity, mortality, and cost. Methods 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. Results 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. Conclusion 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.

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