Mayer S, McGrath LJ, Kim M, McDermott M, Brookhart MA. Prevalence of osteoporosis and its treatment among women≥50 inNHANES: 1999-2018. Poster presented at the Virtual ICPE 2021 Conference; August 2021. [abstract] Pharmacoepidemiol Drug Saf. 2021 Aug; 30(Suppl 1):28. doi: 10.1002/pds.5305

BACKGROUND: Osteoporosis (OP) was estimated to impact 8.2 million women aged≥50 in the United States (US) in 2010, but is significantly undertreated. No recent study has characterized the use of prescrip-tion OP medication (OPRx) in a nationally-representative US population.  

OBJECTIVES: We sought to estimate the prevalence of OP and OPRx use among women≥50 using the cross-sectional National Health and Nutrition Examination Survey (NHANES) from 1999-2018. 

METHODS: Non-institutionalized women≥50 years were sampledevery two years to provide survey and clinical data. We computed weighted OP prevalence estimates and covariate distributions using provided weights. Self-reported OP was based on report of 1) diagno-sis with OP, 2) a fragility fracture (i.e., fracture after age 50 of the hip, wrist or spine as a result of a fall from less than standing height), or 3)use of OPRx in the prior 30 days. In addition, bone mineral density(BMD) scans were available for a subset of women in select survey years. BMD-based OP was defined as BMD≥2.5 standard deviations below the reference mean (women 20-29) at the lumbar spine or fem-oral neck. Lastly, we characterized trends in 30-day OPRx use over al available survey cycles.  

RESULTS: Over 11,000 women completed the OP survey. In weighted data, self-reported OP prevalence increased from 17.3% in1999-2000 to 25.4% in 2017-18. An additional 7.2% of women who did not self-report OP met the BMD-based OP definition, increasing total OP prevalence to a maximum of 30.9% in 2017-18. Total OP prevalence increased across all age and race/ethnicity groups exam-ined, with women aged≥80 and non-Hispanic White women having the highest OP prevalence (51.8 and 30.1%, respectively). Overall,7.1% of all women and 28.9% of women with self-reported OP reported OPRx use, with oral bisphosphonates being the most com-mon OPRx type, followed by raloxifene. Very little use of zoledronicacid, denosumab and teriparatide was observed. OPRx use among women with self-reported OP peaked above 40% between 2003-08and declined to 19.1% in 2017-18. Within this group, OPRx users were more likely to be non-Hispanic White, married, to have at least ahigh school education, to be insured, had fewer comorbidities and were less likely to have ever smoked. Women reporting an OP diag-nosis had the highest prevalence of OPRx use (>29.0%), whereas only5.8% of women reporting fragility fractures and no diagnosis reported OPRx use.  

CONCLUSIONS: We report an upward trend in both diagnosed and undiagnosed OP among women≥50 in the US, while the use of bisphosphonates and raloxifene has declined and remains relatively uncommon among those with indications for treatment.

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