In Denmark, osteoporosis treatment is either handled by general practitioners or at more resource demanding specialist clinics. We evaluated the treatment adherence and persistence in the two settings, which were overall similar. The type of medical support did, however, differ and was provided to two very different patient populations.
The study aimed to investigate the effect of patient care by general practitioners (GPs) or specialists on treatment adherence among osteoporosis patients initiating treatment with oral bisphosphonates (OB).
Dual-energy X-ray absorption (DXA)-scanning data from 2005 to 2013 were extracted. Treatment naïve patients with a T-score ≤ − 2.5 (spine or hip) were included. Information on medical treatment, comorbidities, and socio-economic status was extracted from Danish registries. Scanning results were evaluated by a specialist. Subsequent treatment initiation and follow-up was either handled by GPs or specialists: GP population (GPP) vs. specialist population (SP). Primary adherence was defined as treatment initiating within 12 months from diagnosis and secondary adherence as days with medicine possession rates (MPR) > 80%.
Of 11,201 DXA-scanned patients, 3685 met the inclusion criteria (GPP = 2177, SP = 1508). The GPP consisted of relatively more men, was older, had shorter education, lower income, and more comorbidities. There was no difference in baseline T-score or prior incidence of major osteoporotic fractures (MOFs). The GPP was primarily treated with OB and had better primary adherence (adjusted ORGPP/SP = 1.52 [1.31–1.75], p < 0.0001) than the SP that to a higher degree received another treatment. Secondary adherence was similar (adjusted ORGPP/SP: OR12 months = 1.02 [0.83–1.26]; OR24 months = 0.90 [0.73–1.10]; OR4 years = 0.88 [0.71–1.07]; OR5 years = 0.91 [0.74–1.13].
Patients in care of specialists were most likely to receive a treatment other than OB. Primary adherence was highest in the GPP, whereas short- and long-term persistence was similar for up to 5 years whether treated by a specialist or a GP.
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The authors thank Amgen AB, Hellerup, Denmark, for an unrestricted grant. The authors also thank Katrine Ross-Hansen from MediKat, Copenhagen, Denmark, for providing medical writing support including developing the tables, drafting the results section, and reviewing/revising the final manuscript.
Conflict of interests
Mette Friberg Hitz has received grants from Orkla Care, UCB, Ellab fond, and Amgen and received personal payment in relation to lectures and advisory board meetings. Jakob Praest Holm has participated as a subinvesigator in studies by Amgen and MSD and received payment for lectures sponsored by Amgen and LEO Pharma. Jens-Erik Beck Jensen reports grants and personal fees from Amgen during the conduct of this study, grants and personal fees from Eli Lilly, and personal fees from UCB, Giliad, and Astra Zeneca outside the submitted work. Sofie Arup, Anne Lyngholm Soerensen, and Thomas Alexander Gerds declare that they have no conflict of interests.
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Hitz, M.F., Arup, S., Holm, J.P. et al. Outcome of osteoporosis evaluation, treatment, and follow-up in patients referred to a specialized outpatient clinic compared to patients in care of general practitioners. Arch Osteoporos 15, 97 (2020). https://doi.org/10.1007/s11657-020-00774-9
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