Osteoporosis Management in a Medicaid Population after the Women's Health Initiative Study

Abstract

Objective: Publication of the Women's Health Initiative (WHI) study has changed our understanding on the effects of hormone replacement therapy. This study was designed to evaluate patterns of antiosteoporosis medication (AOM) use in a Medicaid population before and after the release of the WHI study results. Results: The overall prevalence of AOM did not change between pre-WHI and post-WHI study publication. However, there were significant changes in the prevalence of certain AOM drug classes. Estrogen use decreased significantly after the WHI study release for all age and racial groups. The prevalence for bisphosphonates and SERM increased significantly in the post-WHI period.Conclusions: The WHI study influenced patterns of use of all types of AOM, decreasing estrogen and increasing nonestrogen use among postmenopausal women in a Medicaid program. These results suggest that the WHI study affected patterns of use of bone protective pharmacotherapy, with a shift in bone protection therapy use from estrogen to nonestrogen AOMs. 155

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

“…Our findings on patterns of AOM prevalence after the WHI publication were similar to those in the published literature, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] indicating that the prevalence of estrogen use declined by 29%-69% and bisphosphonate use increased by about 18%. Our study found a similar decrease in the prevalence of visits associated with estrogen prescription (46% reduction), but in contrast to those studies, we found a more than 2-fold increase in bisphosphonate-related visits after the WHI publication.…”

“…Several studies have documented changes in patterns of osteoporosis pharmacotherapy after the WHI publication from self-report, automated pharmacy data, Medicaid administrative data, and other national-level data sources. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Based on research findings, both declines in hormone therapy and switches to lowerdose hormone therapy and other alternative antiosteoporosis medications (AOM) occurred after July 2002.…”

The potential impact of new National Osteoporosis Foundation guidance on treatment patterns

“…Nonetheless, there do appear to be important gaps in the appropriate use of such therapy in this age group [29]. Conversely, the study by Lee et al [26] provides some evidence that, by the new NOF Guide criteria, younger postmenopausal women may be over-treated. The proportion of young postmenopausal women treated at the time of the Lee study was, however, still less than recommended by the old NOF Guide.…”

“…For example, in a Medicare health maintenance organization (HMO) in the Boston area in 2002, bone medication use was <20% in women in all age groups [25]. In the Pennsylvania Medicaid population, age 50 and older, Lee et al [26] found that the overall prevalence of anti-osteoporosis medication use was under 15% in December 2002. Further examination of these data revealed that the prevalence of anti-osteoporosis medication use was highest among women in their 50s and declined with each succeeding decade [26].…”

“…In the Pennsylvania Medicaid population, age 50 and older, Lee et al [26] found that the overall prevalence of anti-osteoporosis medication use was under 15% in December 2002. Further examination of these data revealed that the prevalence of anti-osteoporosis medication use was highest among women in their 50s and declined with each succeeding decade [26]. Some degree of undertreatment is to be expected among older women due to over-riding circumstances related to intercurrent illnesses, intolerance to medication, reduced life expectancy, etc [27,28].…”