OBJECTIVES : To assess the treatment patterns and impact of osteoporosis medications on fracture incidence in post-menopausal women in Germany.

METHODS : Retrospective cohort study based on data from a German claims database (WIG2 Benchmark Database). Women aged ≥50 years who received osteoporosis treatment between Jan 2013 and Dec 2017 were included. Fracture incidence rates were assessed in the first 3 months after initiating treatment to establish baseline fracture risk, and treatment effectiveness was evaluated as change in fracture incidence rates from baseline. Patients were followed to therapy discontinuation or switch, end of insurance, or death.

RESULTS

: Number of patients was: oral bisphosphonates = 13,134; intravenous ibandronate = 1,801; zoledronate = 379; denosumab = 3,495. Use of previous osteoporosis treatments was highest in patients who received denosumab (54%) and lowest in those who received oral bisphosphonates (4%). Prior fracture was similar in those receiving denosumab (16%) or bisphosphonates (13-17%). Median duration of therapy was longer with denosumab (587 days) than ibandronate (451 days), zoledronate (389 days) and oral bisphosphonates (258 days). Baseline fracture rate was highest in those receiving denosumab and higher in all groups naïve to prior treatment. All medications reduced the fracture rate during treatment. Relative to the baseline fracture rate, the rate of any fracture decreased with denosumab during all subsequent treatment periods (decreased by 38%, 50%, 56% and 67% in years 1 to 4, respectively) and with oral bisphosphonates (decreased by 39%, 44%, 49%, and 42%). Incidence of clinical vertebral fractures was decreased with denosumab (decreased by 62%, 70%, 74%, and 68%) and with oral bisphosphonates (decreased by 53%, 65%, 72%, and 59%).

CONCLUSIONS : Differences in baseline fracture rate indicate that physicians consider fracture risk when selecting treatment options. Using a within-cohort approach, we show that continued treatment with osteoporosis medications reduced fracture rates in a real-world setting.