Long-Term Effect of the Women's Health Initiative Study on Antiosteoporosis Medication Prescribing

Abstract

After the WHI publication, the overall prevalence of osteoporosis therapy did not change; however, a shift from estrogen to nonestrogen therapy was observed after the WHI publication. Black women were less likely to receive nonestrogen antiosteoporosis therapy in hospital-based clinics.

Changing trends in osteoporosis care from specialty to primary care physicians

“…PCPs wrote fewer prescriptions for bisphosphonates than non-PCPs. However, the volume of patients treated for osteoporosis by their PCPs was greater than that reported in previous national surveys 3,15 . Calcium was a determinant for prescribing osteoporosis treatment with bisphosphonate.…”

“…Medicare patients were highest in proportion for receiving bisphosphonate prescriptions (Figure 1). The volume of outpatient visits to the PCPs (49.5%) for osteoporosis care in the current analysis demonstrates a substantial rise in osteoporosis care (with case identification and treatment) by PCPs since the 1990s (about 10%) 3,15,24,25 . The increasing number of outpatient visits that addressed osteoporosis is a testimony of increasing need and demand for osteoporosis care in older patient population.…”

“…Our data demonstrate the typical older patient population with multiple co-morbidities who are seeking care for osteoporosis to their PCPs; and this indicates the need to prepare PCPs for an increasing and unavoidable burden to their list of chronic diseases in the near future. Lee et al's reports based on NAMCS data from the late 1990s reported only 10% of the outpatient visits between 1997 and 1998 prescribing medications for osteoporosis treatment 15,24 . While Lee and colleagues 24 looked at all outpatient visits for women 40 years or older, another study 3 using NAMCS data from 1993 to 1997 reported similar percentages (about 10%) of White post-menopausal women treated for osteoporosis by PCPs.…”

“…A change to higher rates of bisphosphonate with a decrease in estrogen therapy was noted since the Women's Health Initiative report of deleterious effects of estrogen in women 15 . Similar to that trend, bisphosphonates were the most commonly prescribed medication for osteoporosis care in our analysis for both men and women.…”

“…With about 10,000 baby boomers turning 65 years every day, the demand for osteoporosis care is also increasing daily in the USA 13 . While a growing numbers of outpatient visits by older patients seeking care for osteoporosis indicates increased demand for osteoporosis treatment in the recent years 1,3,14,15 , what percentages of these visits are made to PCPs are unknown. Most studies reporting suboptimal treatment by PCPs date from the 1990s 3,7-10 .…”