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By Setareh Williams, Ph.D., Head of Global Health Economics and Outcomes Research, Radius Health, Inc.

Past and future costs of osteoporosis may be a cause for concern.i It is estimated that the total burden of osteoporosis was more than 2 million incident fractures at a direct cost of almost $17 billion in the United States in 2005.i And, that number is only expected to grow, with research estimating that by 2025, fractures and costs are projected to increase by more than 48 percent to more than 3 million fractures, incurring $25.3 billion in costs.In addition to the direct costs of healthcare, some osteoporosis-related fractures result in loss of physical functioning, including loss of mobility and self-care.ii Given the expected growing incidence and economic burden associated with osteoporosis-related fractures, it is imperative to utilize available diagnostic and therapeutic options to help reduce the impact of illness.i,iii

Osteoporosis-related fractures cause more women 55 and older to be hospitalized each year in the US than breast cancer, heart attacks, or strokes.iv Furthermore, in the year following an osteoporotic vertebral fracture, postmenopausal women are at heightened risk for subsequent fractures.v It’s important to look at the root causes of this crisis. It may be that not enough people are diagnosed with or treated for osteoporosis.

Osteoporosis patients are treated by multiple specialties, including endocrinologists.iii The 2016 diagnosis and treatment guidelines from the American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE), state that patients can be diagnosed with osteoporosis based on a fragility fracture in the absence of other metabolic disorders.iii

Clinical data are now available that substantiate the benefit of initiating an anabolic agent (anabolic agents help build new bone) — which can help reduce fracture risk at 18 months — earlier in the treatment cascade, followed by antiresorptive agents (antiresorptive agents help slow bone loss).vi,vii,viii,ix,x It’s imperative to engage with patients to ensure they are taking their medications and encourage continued and appropriate adherence with their osteoporosis therapies.xi

Both healthcare professionals and patients must be educated about postmenopausal osteoporosis and ways to treat it. Evidence-based guidelines, such as the AACE/ACE recommendations, may help clinicians diagnose osteoporosis to help reduce the burden of fragility fractures.iii

Perhaps it could also be important to evaluate real-world effectiveness and comparative effectiveness to better understand how patients benefit from approved therapies. Could it also be worth evaluating treatment effectiveness in patients with various prior treatment histories and chronic comorbidities?

This growing economic burden of osteoporosis demands that we act, especially because we know how to identify those at risk for osteoporosis, and we have evidence that shows which treatments are effective.i,iii,vi,xii,xiii Each of us — whether we are healthcare professionals, payers or individual patients — can make a difference.

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ii Pisani P, Renna MD, et al. Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop. 2016;7(3):171-181.
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vii Baron R, Hesse E. Update on bone anabolics in osteoporosis treatment: rationale, current status, and perspectives. J Clin Endocrinol Metab. 2012;97(2):311 -325.
viii Khan A·W, Khan A. Anabolic agents: a new chapter in the management of osteoporosis. J Obstet Gynaecol Can. 2006;28(2):136· 141.
ix Seeman E, Martin T J. Co-administration of anti resorptive and anabolic agents: a missed opportunity. J Bone Miner Res. 2015;30(5): 753· 764.
x Bone HG, Cosman F, et al. ACTIVExtend: 24 Months of Alendronate After 18 Months of Abaloparatide or Placebo for Postmenopausal Osteoporosis. JCEM. 2018;103(8): 2949–2957.
xi Cosman F, de Beur SJ, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International. 2014; 25(8).
xii Neer RM, Arnaud CD, et al. Effect Of Parathyroid Hormone (1-34) On Fractures And Bone
Mineral Density In Postmenopausal Women With Osteoporosis. NJEM. 2001;344(19):1434-1441.

xiii Miller PD, Hattersley G, et al. Effect of Abaloparatide vs Placebo on New Vertebral Fractures in Postmenopausal Women With Osteoporosis. JAMA. 2016;316(7):722-733.

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