[Drug therapy in postmenopausal osteoporosis. An analysis of healty service delivery]

Abstract

The current care and management of menopausal women diagnosed with osteoporosis was analysed by using two different data sets. We investigated prescriptions for drugs approved for the treatment of osteoporosis (vitamin D, calcium, fluoride, calcitonin, oestrogen/gestagen combinations, oral bisphosphonates) that were issued by general practitioners and primary care internists between February 1999 and February 2000 to women over 50 years of age diagnosed with osteoporosis (MediPlus database). For orientation purposes these data were compared to treatment data from the core documentation of regional collaborative rheumatology centres for patients with inflammatory rheumatic diseases as their primary diagnosis and osteoporosis as secondary diagnosis. According to the MediPlus database, 64.5% of the patients diagnosed with osteoporosis received some kind of osteoporosis-specific therapy, which in most cases consisted of monotherapy with calcium (34.7%) or a bisphosphonate (8.9%). The number of prescriptions issued per year was between 2.1 and 3.3, depending on the drug class used. This means that a maximum of 108 to 207 days per year was covered by therapy. 1.4% of the patients received combination therapy consisting of calcium plus bisphosphonate and 3% were treated with calcium plus hormone replacement therapy in accordance with the recommendations of the German Osteoporosis Working Group (DAGO). 71% of the female patients over 50 years of age with osteoporosis as a secondary diagnosis received such a therapy in the rheumatology centres. Among this high-risk group of patients, 29% who presented to a rheumatologist for the first time had been administered osteoporosis-specific medication during the previous 12 months as compared to 77% who had previously been given rheumatologic treatment.

Conclusion: The data reveal significant deficits in the primary care treatment of postmenopausal osteoporosis.