Introduction
Materials and methods
Data source
Patient selection
Outcome measures
Treatment cohorts
Analysis
Patient characteristics | Fracture patients | Non-fracture patients |
p value | Total | |||
---|---|---|---|---|---|---|---|
N/mean | Percent/SD |
N/mean | Percent/SD |
N/mean | Percent/SD | ||
Total number of patients | 1527 | 13.4 % | 9880 | 86.6 % | 11,407 | 100 % | |
Age (mean, SD) | 72.4 | 10.5 | 69.1 | 10.5 |
<0.001
| 69.5 | 10.6 |
Age range (N, %) | |||||||
50–54 | 88 | 5.8 % | 851 | 8.6 % |
<0.001
| 939 | 8.2 % |
55–59 | 151 | 9.9 % | 1531 | 15.5 % |
<0.001
| 1682 | 14.7 % |
60–64 | 158 | 10.3 % | 1393 | 14.1 % |
<0.001
| 1551 | 13.6 % |
65–69 | 155 | 10.2 % | 1178 | 11.9 % |
0.045
| 1333 | 11.7 % |
70–79 | 544 | 35.6 % | 3032 | 30.7 % |
<0.001
| 3576 | 31.3 % |
80+ | 431 | 28.2 % | 1895 | 19.2 % |
<0.001
| 2326 | 20.4 % |
Female (N, %) | 1412 | 92.5 % | 9084 | 91.9 % | 0.481 | 10,496 | 92.0 % |
Medicare payer (N, %) | 1146 | 75.0 % | 6167 | 62.4 % |
<0.001
| 7313 | 64.1 % |
Capitated services (N, %) | 38 | 2.5 % | 379 | 3.8 % |
0.009
| 417 | 3.7 % |
Insurance plan type (N, %) | |||||||
Comprehensive | 789 | 51.7 % | 4469 | 45.2 % |
<0.001
| 5258 | 46.1 % |
Point of service | 63 | 4.1 % | 621 | 6.3 % |
0.001
| 684 | 6.0 % |
HMO | 60 | 3.9 % | 623 | 6.3 % |
<0.001
| 683 | 6.0 % |
PPO | 588 | 38.5 % | 3957 | 40.1 % | 0.251 | 4545 | 39.8 % |
Other/unknown | 27 | 1.8 % | 210 | 2.1 % | 0.362 | 237 | 2.1 % |
Region (N, %) | |||||||
Northeast | 124 | 8.1 % | 663 | 6.7 % |
0.043
| 787 | 6.9 % |
North Central | 581 | 38.0 % | 3505 | 35.5 % | 0.051 | 4086 | 35.8 % |
South | 590 | 38.6 % | 4354 | 44.1 % |
<0.001
| 4944 | 43.3 % |
West | 229 | 15.0 % | 1322 | 13.4 % | 0.086 | 1551 | 13.6 % |
Unknown | 3 | 0.2 % | 36 | 0.4 % | 0.296 | 39 | 0.3 % |
DCI (mean, SD) | 0.97 | 1.23 | 0.63 | 0.99 |
<0.001
| 0.68 | 1.03 |
Unique 3-digit ICD-9 codes (mean, SD) | 14.8 | 8.8 | 11.7 | 7.3 |
<0.001
| 12.1 | 7.6 |
Baseline comorbid conditions (N, %) | |||||||
Abnormalities of the esophagus | 53 | 3.5 % | 436 | 4.4 % | 0.091 | 489 | 4.3 % |
Active UGI ulcer | 28 | 1.8 % | 125 | 1.3 % | 0.072 | 153 | 1.3 % |
Alcoholism | 6 | 0.4 % | 30 | 0.3 % | 0.563 | 36 | 0.3 % |
Diabetes | 214 | 14.0 % | 915 | 9.3 % |
<0.001
| 1129 | 9.9 % |
Endocrine disease (excluding diabetes) | 69 | 4.5 % | 354 | 3.6 % | 0.072 | 423 | 3.7 % |
GERD | 180 | 11.8 % | 1111 | 11.2 % | 0.533 | 1291 | 11.3 % |
Renal insufficiency | 2 | 0.1 % | 61 | 0.6 % |
0.017
| 63 | 0.6 % |
Liver disease | 26 | 1.7 % | 181 | 1.8 % | 0.725 | 207 | 1.8 % |
Malabsorption syndrome | 6 | 0.4 % | 59 | 0.6 % | 0.324 | 65 | 0.6 % |
Metabolic bone disease | 31 | 2.0 % | 257 | 2.6 % | 0.186 | 288 | 2.5 % |
Nephritis | 12 | 0.8 % | 52 | 0.5 % | 0.206 | 64 | 0.6 % |
Osteopenia | 137 | 9.0 % | 900 | 9.1 % | 0.862 | 1037 | 9.1 % |
Rheumatoid arthritis | 185 | 12.1 % | 706 | 7.1 % |
<0.001
| 891 | 7.8 % |
Thyroid disease | 222 | 14.5 % | 1319 | 13.4 % | 0.206 | 1541 | 13.5 % |
Fragility-related fractures (N, %) | 544 | 35.6 % | 2376 | 24.0 % |
<0.001
| 2920 | 25.6 % |
Vertebral | 207 | 13.6 % | 1326 | 13.4 % | 0.886 | 1533 | 13.4 % |
Hip | 107 | 7.0 % | 323 | 3.3 % |
<0.001
| 430 | 3.8 % |
Non-hip non-vertebral | 252 | 16.5 % | 793 | 8.0 % |
<0.001
| 1045 | 9.2 % |
Multiple fractures | 22 | 1.4 % | 65 | 0.7 % |
0.001
| 87 | 0.8 % |
Antiresorptive use (N, %) | 1,003 | 65.7 % | 6302 | 63.8 % | 0.150 | 7305 | 64.0 % |
Raloxifene use (N, %) | 205 | 13.4 % | 1357 | 13.7 % | 0.743 | 1562 | 13.7 % |
Antiresorptive agent count (mean, SD) | 1.1 | 0.2 | 1.1 | 0.2 | 0.538 | 1.1 | 0.2 |
Days on antiresorptives (mean, SD) | 209.7 | 102.3 | 219.0 | 100.9 |
0.001
| 217.7 | 101.1 |
Antiresorptive MPR (mean, SD) | 0.73 | 0.26 | 0.75 | 0.25 |
0.004
| 0.75 | 0.25 |
Results
Baseline demographic and clinical characteristics
Post-period fragility-related fractures
Fracture patients | Non-fracture patients |
p value | Overall | ||||
---|---|---|---|---|---|---|---|
N = 1527 |
N = 9880 |
N = 11,407 | |||||
N value | Percent |
N value | Percent |
N value | Percent | ||
Persistent with teriparatide | 623 | 40.8 | 4835 | 48.9 |
<0.001
| 5458 | 47.8 |
Patients with baseline fracture | 234 | 37.6 | 1132 | 23.4 |
<0.001
| 1366 | 25.0 |
And with baseline antiresorptive use | 174 | 27.9 | 777 | 16.1 |
<0.001
| 951 | 17.4 |
And without baseline antiresorptive use | 60 | 9.6 | 355 | 7.3 | 0.514 | 415 | 7.6 |
Patients without baseline fracture | 389 | 62.4 | 3703 | 76.6 |
<0.001
| 4092 | 75.0 |
And with baseline antiresorptive use | 264 | 42.4 | 2534 | 52.4 |
<0.001
| 2798 | 51.3 |
And without baseline antiresorptive use | 125 | 20.1 | 1169 | 24.2 |
<0.001
| 1294 | 23.7 |
Nonpersistent with teriparatide | 904 | 59.2 | 5045 | 51.1 |
<0.001
| 5949 | 52.2 |
Patients with baseline fracture | 310 | 34.3 | 1244 | 24.7 |
<0.001
| 1554 | 26.1 |
And with baseline antiresorptive use | 194 | 21.5 | 787 | 15.6 |
<0.001
| 981 | 16.5 |
And without baseline antiresorptive use | 116 | 12.8 | 457 | 9.1 |
<0.001
| 573 | 9.6 |
Patients without baseline fracture | 594 | 65.7 | 3801 | 75.3 | 0.749 | 4395 | 73.9 |
And with baseline antiresorptive use | 371 | 41.0 | 2204 | 43.7 | 0.084 | 2575 | 43.3 |
And without baseline antiresorptive use | 223 | 24.7 | 1597 | 31.7 | 0.121 | 1820 | 30.6 |
Total | 1527 | 100.0 | 9880 | 100.0 | 11,407 | 100.0 | |
Patients with baseline fracture | 544 | 35.6 | 2376 | 24.0 |
<0.001
| 2920 | 25.6 |
And with baseline antiresorptive use | 368 | 24.1 | 1564 | 15.8 |
<0.001
| 1932 | 16.9 |
And without baseline antiresorptive use | 176 | 11.5 | 812 | 8.2 |
<0.001
| 988 | 8.7 |
Patients without baseline fracture | 983 | 64.4 | 7504 | 76.0 |
<0.001
| 8487 | 74.4 |
And with baseline antiresorptive use | 635 | 41.6 | 4738 | 48.0 |
<0.001
| 5373 | 47.1 |
And without baseline antiresorptive use | 348 | 22.8 | 2766 | 28.0 |
<0.001
| 3114 | 27.3 |
Baseline fragility-related fracture and antiresorptive medication use and relationship to post index fractures
Teriparatide treatment patterns
Teriparatide MPR |
N value | Percent | Mean | SD |
---|---|---|---|---|
Teriparatide persistent patients (N, %) | 5458 | 47.8 | 0.89 | 0.11 |
Teriparatide nonpersistent patients (N, %) | ||||
During the 24-month target treatment duration | 5949 | 52.2 | 0.37 | 0.25 |
While on persistent therapy with teriparatide | 5949 | 52.2 | 0.88 | 0.16 |
During subsequent teriparatide therapy after teriparatide restart | 1104 | 18.6 | 0.81 | 0.24 |
Multivariate analysis
Independent variable | Odds ratio |
p value | 95 % CI lower bound | 95 % CI upper bound |
---|---|---|---|---|
Teriparatide nonpersistence | 1.313 | <0.001 | 1.174 | 1.469 |
Age | 1.027 | <0.001 | 1.022 | 1.033 |
Baseline antiresorptive use | 1.066 | 0.314 | 0.941 | 1.208 |
Gender: female | 1.136 | 0.237 | 0.920 | 1.404 |
Deyo-Charlson comorbidity index score | 1.046 | 0.226 | 0.973 | 1.124 |
Unique 3-digit ICD-9 codes | 1.043 | <0.001 | 1.035 | 1.052 |
Abnormalities of the esophagus | 0.614 | 0.002 | 0.453 | 0.832 |
Active UGI ulcer | 1.007 | 0.976 | 0.647 | 1.568 |
Alcoholism | 1.199 | 0.692 | 0.488 | 2.944 |
Diabetes | 1.178 | 0.106 | 0.966 | 1.436 |
Endocrine disease (excluding diabetes) | 1.157 | 0.304 | 0.876 | 1.527 |
GERD | 0.896 | 0.224 | 0.750 | 1.070 |
Renal insufficiency | 1.060 | 0.74 | 0.752 | 1.494 |
Liver disease | 0.759 | 0.208 | 0.494 | 1.166 |
Malabsorption syndrome | 0.644 | 0.32 | 0.270 | 1.534 |
Metabolic bone disease | 0.683 | 0.055 | 0.462 | 1.009 |
Nephritis | 0.981 | 0.954 | 0.508 | 1.894 |
Osteopenia | 0.985 | 0.883 | 0.811 | 1.197 |
Rheumatoid arthritis | 1.489 | <0.001 | 1.234 | 1.796 |
Thyroid disease | 1.004 | 0.961 | 0.856 | 1.178 |