Study Finds Fracture in Osteoporosis Care

Our bones are a limited resource. Osteoporosis is the most common bone-weakening disease, affecting 10 million older people a year in the United States alone. Studies have shown that anabolic osteoporosis therapies can stimulate the body’s natural tissue-forming processes to bring bone mass closer to normal levels, followed by anti-resorptive medications that slow subsequent natural bone breakdown.

However, a new study led by researchers from the University of Maryland Institute for Health Computing (UM-IHC), the Mayo Clinic and the University of Florida reveals that two-thirds of patients receiving anabolic treatment are not appropriately transitioned to the crucial anti-resorptive therapy afterward. The study, supported by the National Institutes of Health’s National Institute on Aging, was published this week in the journal JAMA Internal Medicine.

“This is a severe gap in care nationally that has until now been under-recognized,” said one of the study’s principal investigators, Rozalina McCoy, director of UM-IHC’s Center for Population Health.

“Follow-up therapy is essential to preserve bone density gains and prevent future fractures,” said McCoy, an associate professor of medicine in the University of Maryland School of Medicine and an adjunct associate professor in the University of Maryland School of Public Health. “Without it, patients who have been invested in and who have benefited from treatment will likely lose significant ground, their treatment gains reversed.”

Every three seconds, someone in the world breaks a bone due to osteoporosis; 80% of those who develop the disease are women, and half of them will sustain a fracture as a result.

In a step toward improving these odds, the researchers examined real-world clinical practice patterns across the United States, using more than 68,000 insurance claims from 2009 to 2022 that had been stripped of personally identifying information. The data showed that about half of osteoporosis patients received no anti-resorptive follow-up therapy after their original treatment, and only 27% received it correctly and within three months of treatment. This is despite consistent guidelines from the Endocrine Society and others, and the FDA’s approved sequence requiring timely follow-up anti-resorptive therapy.

“This is a major missed opportunity to improve outcomes and reduce hip fractures in particular, which carry a substantial morbidity, mortality and economic burden,” McCoy said.

Despite significant clinical and public health ramifications, the broad lack of post-anabolic management is an actionable gap, said McCoy.

She and her colleagues are developing a shared decision-making guide to support conversations between physicians and patients about the available effective osteoporosis treatment options to ensure the greatest benefit with the least harm and the lightest treatment burden. 

“Patients also need to know that when they start osteoanabolic therapy, they will have to follow that course with anti-resorptive therapy—no matter what,” she said.