Patterns and predictors of osteoporosis medication discontinuation and switching among Medicare beneficiaries. uri icon


  • BACKGROUND: Low adherence to bisphosphonate therapy is associated with increased fracture risk. Factors associated with discontinuation of osteoporosis medications have not been studied in-depth. This study assessed medication discontinuation and switching patterns among Medicare beneficiaries who were new users of bisphosphonates and evaluated factors possibly associated with discontinuation. METHODS: We identified patients initiating bisphosphonate treatment using a 5% random sample of Medicare beneficiaries with at least 24months of traditional fee-for-service and part D drug coverage from 2006 through 2009. We classified medication status at the end of follow-up as: continued original bisphosphonate, discontinued without switching or restarting, restarted the same drug after a treatment gap ( 90days), or switched to another anti-osteoporosis medication. We conducted logistic regression analyses to identify baseline characteristics associated with discontinuation and a case-crossover analysis to identify factors that precipitate discontinuation. RESULTS: Of 21,452 new users followed respectively for 12months, 44% continued their original therapy, 36% discontinued without switching or restarting, 8% restarted the same drug after a gap greater than 90days, and 11% switched to another anti-osteoporosis medication. Factors assessed during the 12-month period before initiation were weakly associated with discontinuation. Several Factors measured during follow-up were associated with discontinuation, including more physician visits, hospitalization, having a dual-energy X-ray absorptiometry test, higher Charlson comorbidity index scores, higher out-of-pocket drug payments, and upper gastrointestinal problems. Patterns were similar for 4,738 new users followed for 30months. CONCLUSIONS: Among new bisphosphonates users, switching within and across drug classes and extended treatment gaps are common. Robust definitions and time-varying considerations should be considered to characterize medication discontinuation more accurately.

altmetric score

  • 1

author list (cited authors)

  • Yun, H., Curtis, J. R., Guo, L., Kilgore, M., Muntner, P., Saag, K., ... Delzell, E.

citation count

  • 33

complete list of authors

  • Yun, Huifeng||Curtis, Jeffrey R||Guo, Lingli||Kilgore, Meredith||Muntner, Paul||Saag, Kenneth||Matthews, Robert||Morrisey, Michael||Wright, Nicole C||Becker, David J||Delzell, Elizabeth