comparison of osteoporosis pharmacotherapy fracture rates: analysis of a marketscan® claims database cohort

Background: several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. no study has compared real world efficacy at preventing fractures between all currently approved medications. objectives: to directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database. methods: the truven health analytics marketscan® database from 2008 2012 was used to identify all patients who started a new osteoporosis medication. patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. logistic regression was used to account for and quantify the contribution of risk factors, and to make direct comparisons between different osteoporosis medications. results: a total of 51649 patients were included in the cohort, with an average age of 56 years. the overall incidence rate of fracture was 1.55 per 100 person years of treatment. orally administered medications had the lowest fracture rates, led by raloxifene and alendronate (1.24 and 1.54 respectively), while parenterally administered medications including teriparatide and zolerdonic acid had the highest rates (3.90 and 1.98 respectively). no statistically significant differences found between oral or parenterally administered bisphosphonate medications. conclusions: while patients taking orally administered drugs including bisphosphonates had less frequent incident fracture no statistically significant differences were found between most drugs in head to head comparisons, even considering the route of administration of bisphosphonates. these findings support previous evidence that minimal differences in efficacy exist between different osteoporosis medications. this is the first study using a large database to compare all currently available osteoporosis treatments and will hopefully be augmented by further study to provide more evidence to make clinical decisions on osteoporosis medication use.