Reasons for bisphosphonate exclusion in patients treated for osteoporosis

Inadequate treatment is a concern in management of osteoporosis because of its negative impact on fracture risk, health care costs, and quality of life. Bisphosphonates are the most effective drug class at decreasing hip and spine fractures. The purpose of the study was to discover reasons for exclusion of bisphosphonates in the treatment of patients with osteoporosis.

A cross-sectional study of electronic medical records.

Academic family medicine outpatient clinics.

Subset of patients older than 25 years of age who had a diagnosis of osteoporosis and were not on bisphosphonate treatment on December 31, 2007.

The primary endpoint was the reason patients were not on bisphosphonate therapy. Secondary endpoints included the length of previous bisphosphonate therapy and the number of patients receiving other prescription treatments for osteoporosis.

Of 698 patients with osteoporosis, 418 (60%) were not treated with a bisphosphonate. Patients were 91.6% female and 76.4% white, with a mean age of 77.5 ± 13.5 years. Of the random sample of 191 patients, 17 (8.9%) patients did not have an identifiable reason for bisphosphonate exclusion. The most common reasons were gastrointestinal (GI) diagnosis (28%), low functional status (24%), and poor renal function (12%). Almost half (44.5%) of patients were previously on a bisphosphonate, with an average use of 20.7 ± 17.7 months. Only 2.6% of patients received osteoporosis treatment other than a bisphosphonate.

Even though 60% of patients were not prescribed a bisphosphonate, 91.1% had a reason for exclusion. With GI reasons most common, parenteral forms of bisphosphonates recently approved for osteoporosis may increase use.