A programmatic approach to osteoporosis treatment: insight from a 20-year longitudinal study

The rationale for this research is to analyze the osteoporosis treatment rate over a 20-year period to understand and improve patient care. The main result of the study indicates that patients who were seen in a structured osteoporosis clinic had significantly higher treatment rates compared to the national benchmark. The significance of this model lies in its ability to provide focused osteoporosis care, which can effectively bridge the existing care gap.

Osteoporosis is underserved. We studied the impact of an osteoporosis care program on treatment rates over a 20-year period.

This retrospective study 2002-2022 analyzed 3- and 5-year osteoporosis treatment trends across seven 3-year time periods. Treatment rates were compared by visit type (Primary Care Physician [PCP] vs. non-PCP [specialty clinic or osteoporosis clinic]), insurance type, gender, and race. Statistical comparisons within each period were made using chi-square, Fisher's exact tests, or logistic regression with generalized estimating equations (GEE).

Among 44,135 patient records (median age 76), treatment rates declined over time, 73.9% to 56.5% (3-year, p = 0.003) and 72.7% to 47.4% (5-year, p < 0.0001). Osteoporosis clinic had overall similar treatment rates as specialty clinic (3-year: 70.2% vs. 67.2%, p = 0.124; 5-year: 60.2% vs. 57.9%, p = 0.856) but higher rates in time-stratified analysis. The osteoporosis clinic had higher treatment rates than PCP clinics (3-year: 70.2% vs. 56.1%, p < 0.0001; 5-year: 60.2% vs. 48.5%, p < 0.0001). Treatment rates were similar by insurance type and race. Women had higher overall treatment rates than men.

Over two decades, our osteoporosis team reported significantly higher treatment rates than national averages. Overall treatment rates were similar between patients seen in osteoporosis and specialty clinic; however, the osteoporosis clinic reported higher rates than the specialty or PCP clinic in time-stratified analysis and PCP clinic overall. Differences in disease severity and treatment receptivity across care settings may have influenced outcomes. Treatment rates were consistent across insurance types,but gender disparities persisted. Conclusions about race were limited by the small non-white population.