Real-world bone turnover marker use: impact on treatment decisions and fracture
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ORIGINAL ARTICLE
Real-world bone turnover marker use: impact on treatment decisions and fracture N. E. Lane 1
&
K. Saag 2
&
T. J. O’Neill 3 & M. Manion 4 & R. Shah 3
&
U. Klause 5 & R. Eastell 6
Received: 19 August 2020 / Accepted: 5 November 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary The use of bone turnover marker (BTM) testing for patients with osteoporosis in the USA has not been well characterized. This retrospective US-based real-world data study found BTM testing has some association with treatment decisionmaking and lower fracture risk in patients with presumed osteoporosis, supporting its use in clinical practice. Introduction The purpose of this study was to characterize bone turnover marker (BTM) testing patterns and estimate their clinical utility in treatment decision-making and fragility fracture risk in patients with osteoporosis using a retrospective claims database. Methods Data from patients aged ≥ 50 years with newly diagnosed osteoporosis enrolled in the Truven MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Co-ordination of Benefits databases from January 2008 to June 2018 were included. Osteoporosis was ascertained by explicit claims, fragility fracture events associated with osteoporosis, or prescribed anti-resorptive or anabolic therapy. BTM-tested patients were 1:1 propensity score matched to those untested following diagnosis. Generalized estimating equation models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for testing versus no testing on both treatment decision-making and fragility fracture. Results Of the 457,829 patients with osteoporosis, 6075 were identified with ≥ 1 BTM test following diagnosis; of these patients, 1345 had a unique treatment decision made ≤ 30 days from BTM testing. The percentage of patients receiving BTM tests increased significantly each year (average annual % change: + 8.1%; 95% CI: 5.6–9.0; p = 0.01). Patients tested were significantly more likely to have a treatment decision (OR: 1.14; 95% CI: 1.13–1.15), and testing was associated with lower odds of fracture versus those untested (OR: 0.87; 95% CI: 0.85–0.88). Conclusion In this large, heterogeneous population of patients with presumed osteoporosis, BTM testing was associated with treatment decision-making, likely leading to fragility fracture reduction following use. Keywords Biochemical markers . Bone turnover . Fracture risk . Monitoring treatment . Osteoporosis
Introduction * N. E. Lane [email protected] 1
Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA
2
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
3
Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
4
Roche Diagnostics, Indianapolis, IN, USA
5
Roche Diabetes Care, Roche Diagnostics, Indianapolis, IN, USA
6
Metabolic Bone Centre, Northe
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