Eleven years secular trend of the initiation of anti-osteoporosis medications and subsequent fractures in Taiwan: From 2008 to 2018

Tsung-Han Yang; Chen-Yu Wang; Shau-Huai Fu; Ding-Cheng Chan; Ho-Min Chen; Jou-Wei Lin; Chun-Feng Huang; Jen-Jia Yang; Chih-Hsing Wu; Jawl-Shan Hwang; Rong-Sen Yang

doi:10.1016/j.jfma.2023.05.023

Eleven years secular trend of the initiation of anti-osteoporosis medications and subsequent fractures in Taiwan: From 2008 to 2018

J Formos Med Assoc. 2023:122 Suppl 1:S36-S44. doi: 10.1016/j.jfma.2023.05.023. Epub 2023 Jun 5.

Authors

Tsung-Han Yang¹, Chen-Yu Wang², Shau-Huai Fu³, Ding-Cheng Chan⁴, Ho-Min Chen⁵, Jou-Wei Lin⁶, Chun-Feng Huang⁷, Jen-Jia Yang⁸, Chih-Hsing Wu⁹, Jawl-Shan Hwang¹⁰, Rong-Sen Yang¹¹

Affiliations

¹ Department of Orthopedics, NTU BioMedical Park Hospital, NTUH Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.
² School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
³ Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Health Data Research Center, National Taiwan University, Taipei, Taiwan.
⁶ Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin County, Taiwan.
⁷ Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan.
⁸ Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Po Jen General Hospital, Taipei, Taiwan.
⁹ Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang GungUniversit, Taoyuan, Taiwan. Electronic address: hwang2570@gmail.com.
¹¹ Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: rsy0819@gmail.com.

PMID: 37280138
DOI: 10.1016/j.jfma.2023.05.023

Abstract

Background: Osteoporosis is a common metabolic bone disease that benefits from many newly developed anti-osteoporosis medications (AOMs). Reimbursement policies need to allocate medical budgets properly based on evidence-based data. This study aimed to investigate the 11-year secular trend, focusing on older age and males in this adjustment wave of the National Health Insurance reimbursement.

Methods: We adopted a nationwide cohort from Taiwan's National Health Insurance Research Database (NHIRD). Patients undergoing newly initiated AOMs from 2008 to 2018 were included. The AOMs in this study included denosumab, zoledronate, ibandronate, alendronate, raloxifene, and risedronate. Patients <50 years, pathological fractures, missing data, and two AOMs prescribed were excluded. The real-world trends related to subsequent fragility fracture and death within 1 and 3 years were used to evaluate the potential effects due to revision of reimbursement policies.

Results: Of 393,092 patients, among them, 336,229 patients met the criteria, whose mean age ranged from 73.3 to 74.4 years, and nearly 80% were female. Further analysis showed a steady increase of AOMs from 5567 (17.1%) and 8802 (27.0%) in 2008-6697 (18.3%) and 10,793 (29.5%) in 2018 for males and 80+ years respectively. The subsequent fragility fracture within one and three years post AOMs initiation was 5.81% and 11.80% in 2018.

Conclusion: This study showed an immediate drop in AOMs prescription after the implementation of a new stricter reimbursement policy. It took 5 years to return the annual prescription number.

Keywords: Anti-Osteoporosis medications; Osteoporosis; Secular trend; Subsequent fractures.

MeSH terms

Aged
Alendronate / therapeutic use
Bone Density Conservation Agents* / therapeutic use
Female
Fractures, Bone* / drug therapy
Humans
Male
Osteoporosis* / drug therapy
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / prevention & control
Taiwan

Substances

Bone Density Conservation Agents
Alendronate