Real-world bone turnover marker use:​ impact on treatment decisions and fracture

Lane, N. E.<sup>1</sup>; Saag, K.<sup>2</sup>; O’Neill, T. J.<sup>3</sup>; Manion, M.<sup>4</sup>; Shah, R.<sup>3</sup>; Klause, U.<sup>5</sup>; Eastell, R.<sup>6</sup>

Affiliations

¹Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA

²Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA

³Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA

⁴Roche Diagnostics, Indianapolis, IN, USA

⁵Roche Diabetes Care, Roche Diagnostics, Indianapolis, IN, USA

⁶Metabolic Bone Centre, Northern General Hospital, Sheffield, UK

Abstract and keywords

Summary: The use of bone turnover marker (BTM) testing for patients with osteoporosis in the USA has not been well characterized. This retrospective US-based real-world data study found BTM testing has some association with treatment decision-making and lower fracture risk in patients with presumed osteoporosis, supporting its use in clinical practice.

Introduction: The purpose of this study was to characterize bone turnover marker (BTM) testing patterns and estimate their clinical utility in treatment decision-making and fragility fracture risk in patients with osteoporosis using a retrospective claims database.

Methods: Data from patients aged ≥ 50 years with newly diagnosed osteoporosis enrolled in the Truven MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Co-ordination of Benefits databases from January 2008 to June 2018 were included. Osteoporosis was ascertained by explicit claims, fragility fracture events associated with osteoporosis, or prescribed anti-resorptive or anabolic therapy. BTM-tested patients were 1:1 propensity score matched to those untested following diagnosis. Generalized estimating equation models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for testing versus no testing on both treatment decision-making and fragility fracture.

Results: Of the 457,829 patients with osteoporosis, 6075 were identified with ≥ 1 BTM test following diagnosis; of these patients, 1345 had a unique treatment decision made ≤ 30 days from BTM testing. The percentage of patients receiving BTM tests increased significantly each year (average annual % change: + 8.1%; 95% CI: 5.6–9.0; p = 0.01). Patients tested were significantly more likely to have a treatment decision (OR: 1.14; 95% CI: 1.13–1.15), and testing was associated with lower odds of fracture versus those untested (OR: 0.87; 95% CI: 0.85–0.88).

Conclusion: In this large, heterogeneous population of patients with presumed osteoporosis, BTM testing was associated with treatment decision-making, likely leading to fragility fracture reduction following use.

Keywords: Biochemical markers; Bone turnover; Fracture risk; Monitoring treatment; Osteoporosis

Links

DOI: 10.1007/s00198-020-05734-0

PubMed: 33236195

WoS: 000592136900002

History

Received: 2020-08-19

Accepted: 2020-11-05

Online: 2020-11-24

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