Introduction
Methods
Subjects
Data sources and measures
Study questionnaire (self-report of drug use and DXA testing)
DXA confirmation and DXA—documented osteoporosis
Healthcare utilization data—medical claims
Healthcare utilization data—pharmacy claims
Data linkage and eligibility
Statistical analysis
Results
Characteristics of study participants
Characteristica
|
N
| Percentb
|
---|---|---|
Caucasian | 825 | 96.2 |
Primary language English | 707 | 82.4 |
Marital status | ||
Married/common-law | 389 | 45.4 |
Separated/divorced | 51 | 6.0 |
Single/widow | 416 | 48.6 |
Highest level of education | ||
Grade school (through to grade 8) only | 187 | 21.9 |
High school (through to grade 13) | 477 | 55.9 |
Post-secondary (at least some college or university) | 189 | 22.2 |
Smoking status | ||
Never | 514 | 60.1 |
Current | 78 | 9.1 |
Past | 263 | 30.8 |
Region of residencec
| ||
Metropolitan area | 401 | 46.7 |
Small city | 182 | 21.2 |
Town/rural | 275 | 32.1 |
Clinical risk factors for fracture | ||
Low trauma fracture since age 40 | 214 | 24.9 |
Family history of osteoporosis | 240 | 28.0 |
Maternal history of hip fracture | 53 | 6.2 |
Fall in the past year | 221 | 25.8 |
Early menopause (<45 years) | 202 | 23.5 |
Body weight, <57 kg | 215 | 25.1 |
Height loss, >4 cm | 146 | 17.0 |
Current medication or supplement use | ||
Calcium supplement | 425 | 49.5 |
Non-estrogen bone-sparing agentd
| 173 | 20.2 |
Hormone therapy | 71 | 8.3 |
Oral steroids | 19 | 2.2 |
Thyroid medication | 155 | 18.1 |
Agreement between self-report and pharmacy claims-based treatment
Description | Questionnairea
| ODB datab
| Comparison criteria | Kappa statisticc
| |||
---|---|---|---|---|---|---|---|
No. | % | No. | % |
κ
| 95% CI | ||
Osteoporosis pharmacotherapyd
| |||||||
Any bisphosphonate | |||||||
Current | 168 | 19.6 | 149 | 17.4 | Dichotomous (current or not) | 0.83 | 0.78, 0.88 |
Past | 36 | 4.2 | 38 | 4.4 | Dichotomous (ever or never) | 0.80 | 0.75, 0.85 |
Never | 653 | 76.2 | 671 | 78.2 | Ordinal (current, past, never) | 0.81 | 0.77, 0.85 |
Etidronate | |||||||
Current | 94 | 11.0 | 89 | 10.4 | Dichotomous (current or not) | 0.86 | 0.80, 0.92 |
Past | 55 | 6.4 | 43 | 5.0 | Dichotomous (ever or never) | 0.73 | 0.67, 0.79 |
Never | 708 | 82.6 | 726 | 84.6 | Ordinal (current, past, never) | 0.78 | 0.73, 0.83 |
Alendronate | |||||||
Current | 39 | 4.6 | 34 | 4.0 | Dichotomous (current or not) | 0.81 | 0.72, 0.91 |
Past | 14 | 1.6 | 8 | 0.9 | Dichotomous (ever or never) | 0.70 | 0.59, 0.81 |
Never | 804 | 93.8 | 816 | 95.1 | Ordinal (current, past, never) | 0.75 | 0.65, 0.85 |
Risedronate | |||||||
Current | 35 | 4.1 | 28 | 3.3 | Dichotomous (current or not) | 0.79 | 0.67, 0.90 |
Past | –e
| –e
| 9 | 1.1 | Dichotomous (ever or never) | 0.79 | 0.69, 0.89 |
Never | 819 | 95.6 | 821 | 95.7 | Ordinal (current, past, never) | 0.79 | 0.69, 0.89 |
Nasal calcitonin | |||||||
Current | –e
| –e
| –e
| –e
| Dichotomous (current or not) | 0.40 | −0.14, 0.94 |
Past | –e
| –e
| –e
| –e
| Dichotomous (ever or never) | 0.28 | −0.15, 0.72 |
Never | 851 | 99.3 | 857 | 99.9 | Ordinal (current, past, never) | 0.33 | −0.15, 0.82 |
Raloxifene | |||||||
Current | 7 | 0.8 | –e
| –e
| Dichotomous (current or not) | 0.66 | 0.35, 0.97 |
Past | –e
| –e
| –e
| –e
| Dichotomous (ever or never) | 0.58 | 0.31, 0.86 |
Never | 846 | 98.7 | 852 | 99.3 | Ordinal (current, past, never) | 0.62 | 0.34, 0.90 |
Other medications | |||||||
Hormone replacement therapy | |||||||
Current | 71 | 8.3 | 57 | 6.6 | Dichotomous (current or not) | 0.75 | 0.66, 0.83 |
Past | 265 | 30.9 | 47 | 5.5 | Dichotomous (ever or never) | 0.33 | 0.28, 0.39 |
Never | 521 | 60.8 | 754 | 87.9 | Ordinal (current, past, never) | 0.44 | 0.38, 0.50 |
Oral steroids | |||||||
Current | 19 | 2.2 | 18 | 2.1 | Dichotomous (current or not) | 0.59 | 0.40, 0.78 |
Past | 82 | 9.6 | 18 | 2.1 | Dichotomous (ever or never) | 0.35 | 0.25, 0.46 |
Never | 756 | 88.2 | 822 | 95.8 | Ordinal (current, past, never) | 0.41 | 0.30, 0.51 |
Thyroid medication (e.g., Synthroid® or Eltroxin®) | |||||||
Current | 155 | 18.1 | 169 | 19.7 | Dichotomous (current or not) | 0.92 | 0.88, 0.95 |
Past | 30 | 3.5 | –e
| –e
| Dichotomous (ever or never) | 0.86 | 0.81, 0.90 |
Never | 672 | 78.4 | 686 | 80.0 | Ordinal (current, past, never) | 0.88 | 0.85, 0.92 |
Validity of claims data to identify DXA testing
Percent with DXA identified using medical services claims data,a lookback period | |||||
---|---|---|---|---|---|
1 year | 2 years | 3 years | 5 years | From 1991c
| |
DXA confirmed by physician, n = 379 | 35.9 | 60.7 | 75.2 | 90.0 | 97.9 |
DXA not confirmed by physician, n = 27 | 0.0 | 7.4 | 11.1 | 18.5 | 29.6 |
Missing,b
n = 95 | 25.3 | 47.4 | 64.2 | 74.7 | 87.4 |
Validity of claims data to identify DXA-documented osteoporosis
Medical and pharmacy claims | DXA-documented osteoporosis (T-score ≤ −2.5) | |
---|---|---|
Yes, N = 114 | No, N = 245 | |
Sensitivity (95% CI) | Specificity (95% CI) | |
Within 365 days before DXA date | ||
Any osteoporosis diagnostic codea
| 28.9 (20.8, 38.2) | 91.0 (86.7, 94.3) |
Any pharmacotherapy for osteoporosisb
| 52.6 (43.1, 62.1) | 80.8 (75.3, 85.6) |
Any osteoporosis diagnostic code and/or pharmacotherapy | 61.4 (51.8, 70.4) | 78.4 (72.7, 83.4) |
Any osteoporosis diagnostic code and pharmacotherapy | 20.2 (13.2, 28.7) | 93.5 (89.6, 96.2) |
Within 365 days after DXA date | ||
Any osteoporosis diagnostic codea
| 43.0 (33.7, 52.6) | 85.3 (80.2, 89.5) |
Any pharmacotherapy for osteoporosisb
| 71.1 (61.8, 79.2) | 79.2 (73.6, 84.1) |
Any osteoporosis diagnostic code and/or pharmacotherapy | 79.8 (71.3, 86.8) | 72.2 (66.2, 77.8) |
Any osteoporosis diagnostic code and pharmacotherapy | 34.2 (25.6, 43.7) | 92.2 (88.2, 95.3) |