Osteoporosis pharmacotherapy and counseling services in US ambulatory care clinics: opportunities for multidisciplinary interventions

Abstract

Objective: This study was conducted to assess rates and predictors of osteoporosis management with medication or nonmedication therapy, and to compare rates of medication and nonmedication therapy in office-based and hospital-based ambulatory care settings in the United States.

Methods: This cross-sectional study included data on all ambulatory office visits made by patients aged >or=60 years in 2000-2005 in 2 national survey databases representing US ambulatory clinics. Visits with and without a record of anti-osteoporosis medication were identified, and bivariate and multivariate analyses were performed to determine predictive factors for receipt of medication or nonmedication therapy for the prevention and treatment of osteoporosis.

Results: During 2000-2005, visits by patients with a diagnosis of osteoporosis or fragility fracture represented <2% of all visits in office- and hospital-based ambulatory care settings. Medication therapy for osteoporosis was documented in 53.2% of these visits, and nonmedication therapy was documented in 31.5%. The most frequently prescribed drug class was bisphosphonates (36.0%), followed by calcium and vitamin D supplementation (23.9%). The most commonly used nonmedication therapies were exercise (16.7%) and diet/nutrition counseling (19.4%). Rates of medication therapy did not differ significantly by ambulatory care setting. However, visits to hospital-based clinics were significantly less likely than visits to office-based clinics to involve nonmedication therapy (adjusted odds ratio [OR] = 0.6; 95% CI, 0.5-0.9; P = 0.004). Compared with visits by women, visits by men were significantly less likely to involve medication therapy (adjusted OR = 0.6; 95% CI, 0.4-0.9; P = 0.013), nonmedication therapy (adjusted OR = 0.3; 95% CI, 0.2-0.6; P < 0.001), or any therapy (adjusted OR = 0.4; 95% CI, 0.3-0.6; P<0.001). Patients aged >or=80 years were significantly less likely to receive nonmedication therapy than were those aged 60 to 69 years (adjusted OR = 0.6; 95% CI, 0.4-0.9; P = 0.023). Visits by patients with public insurance were significantly less likely to involve medication therapy than visits by patients with other sources of payment (adjusted OR = 0.7; 95% CI, 0.5-1.0; P = 0.040). No difference in the prevalence of any type of therapy was observed in relation to race.

Conclusions: Based on the prevalence of medication and nonmedication therapies, levels of osteoporosis care did not differ by ambulatory care setting. However, patterns of care varied by certain visit characteristics, including insurance type, age, and sex.