Prescription Behaviors of Primary Care Providers in Osteoporosis Management: A Survey

Background Osteoporotic fractures impose a substantial economic burden in the United States. Although multiple pharmacologic therapies reduce fracture risk, variation exists in prescribing patterns. Internal organizational data from our institution demonstrated disproportionate utilization of denosumab compared with zoledronic acid despite substantial cost differences. This study evaluated prescribing attitudes, cost awareness, and determinants influencing primary care providers' osteoporosis medication selection. Methods A cross-sectional survey of primary care providers in New Mexico was conducted from April 18 to May 16, 2022. A convenience and snowball sampling strategy was used. Descriptive statistics, 95% confidence intervals, and chi-square testing were performed for subgroup analysis. An internal document review to determine relative acquisition costs of denosumab and zoledronic acid, and a limited literature review on this topic, were also conducted. Results Seventy-two providers responded (36% response rate). Although 75% reported prescribing denosumab more frequently, 48.6% incorrectly believed denosumab was similarly priced or less expensive than zoledronic acid. Only 26% correctly identified denosumab as much more expensive. Advanced practice clinicians underestimated costs more frequently than physicians (71% vs. 38%, χ²=6.36, p=0.012). Providers practicing >10 years also demonstrated significant underestimation (51.9%). Conclusion Primary care providers frequently underestimate the cost of denosumab despite reporting that cost influences prescribing decisions. Even long-practicing physicians demonstrated substantial misperception of drug pricing. Improved access to real-time cost information may promote more cost-effective osteoporosis management.