Real world treatment of patients with osteoporosis in Germany: A subgroup analysis of patients with severe osteoporosis

Introduction:

This study was conducted to obtain epidemiological insights into the number of patients with severe osteoporosis (OP) as well as their characteristics and treatment.

Methods:

The data for this analysis was provided by a German statutory sick fund, (AOK PLUS; 3.0 million insured persons in 2016, 24.07% female patients (≥55 years) and 14.49% male patients (≥60years)). Patients with at least one OP diagnosis (ICD-10 codes M80.*/M81.*) between 2010 and 2016 were included. All observations were done for OP patients alive in 2016. Based on the DVO criteria, patients were assumed to have severe osteoporosis at high risk of fracture(s) (fx) in 2016 if they [1] experienced prior vertebral or femoral fx from 2014 – 2016, [2] showed other constellations requiring an OP treatment and experienced at least one prior non-vertebral/non-femoral fx from 2010 – 2016 or one prior vertebral or femoral fx in 2010 – 2013 or [3] if they suffered from fx and a glucocorticoid induced osteoporosis (GIOP) from 2010 – 2016. Numbers of affected patients based on above AOK PLUS data were extrapolated to the entire German population, based on age and gender of patients.

Results:

Based on 177,802 OP-prevalent patients alive in 2016, [1] 22,599 female patients (≥55 years) and 3,874 male patients (≥60years) had a severe OP due to a vertebral or femoral fracture between 2014 – 2016 (extrapolated to 401,034 female (≥55 years) and 84,596 male (≥60 years) patients in Germany). [2] 11,084 women (≥55 years) and 810 men (≥60 years) in the AOK PLUS population showed other constellations requiring an OP treatment and experienced at least one prior non-vertebral/non-femoral fx from 2010 – 2016 or one prior vertebral or femoral fx from 2010 – 2013 (extrapolated to 212,566 women (≥55 years) and 18,014 men (≥60 years) in Germany). [3] Finally, 231 women aged ≥55 years and 55 men aged ≥60 years in the AOK PLUS database had experienced a fracture in 2010 – 2016 and were diagnosed with GIOP. In total 33,914 women aged ≥55 years and 4,739 men aged ≥60 were classified with severe OP at high risk of fractures in the AOK PLUS population. The treatment of the biggest of above groups (prevalent vertebral or femoral fx), i.e. 22,599 female and 3,874 male patients, was: Bisphosponates 21.6% for males and 25.0% for females; Bisphosponates comb.: 5.2% males/5.8% females; Strontium ranelate: 0.2% males/0.5% females; Denosumab: 5.8% males/8.7% females; Teriparatide: 0.5% males/0.7% females; Estrogens: 4.6% females; Estrogen comb.: 0.2% females; and Raloxifene: 0.35% for females.

Discussion:

Our study identified a high number of patients with severe OP and high risk of fx in Germany in 2016. The majority of these patients experienced a vertebral or femoral fx and should receive an OP medication according to the DVO guidelines. Reference: DVO Leitlinie Osteoporose 2017