Drug utilization analysis of osteoporosis medications in seven European electronic health databases

Eng Hooi Tan, Danielle E. Robinson, Annika M. Jödicke, Mees Mosseveld, Katrine Bødkergaard, Carlen Reyes, Alireza Moayyeri, Annemarie Voss, Ettore Marconi, Francesco Lapi, Jonas Reinold, Katia M.C. Verhamme, Lars Pedersen, Malte Braitmaier, Marcel de Wilde, Marc Far Ruiz, María Aragón, Pauline Bosco-Levy, Regis Lassalle, Daniel Prieto-Alhambra*Maria T. Sanchez-Santos

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
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We studied the characteristics of patients prescribed osteoporosis medication and patterns of use in European databases. Patients were mostly female, older, had hypertension. There was suboptimal persistence particularly for oral medications. Our findings would be useful to healthcare providers to focus their resources on improving persistence to specific osteoporosis treatments. 


To characterise the patients prescribed osteoporosis therapy and describe the drug utilization patterns. Methods: We investigated the treatment patterns of bisphosphonates, denosumab, teriparatide, and selective estrogen receptor modulators (SERMs) in seven European databases in the United Kingdom, Italy, the Netherlands, Denmark, Spain, and Germany. In this cohort study, we included adults aged ≥ 18 years, with ≥ 1 year of registration in the respective databases, who were new users of the osteoporosis medications. The study period was between 01 January 2018 to 31 January 2022.


Overall, patients were most commonly initiated on alendronate. Persistence decreased over time across all medications and databases, ranging from 52–73% at 6 months to 29–53% at 12 months for alendronate. For other oral bisphosphonates, the proportion of persistent users was 50–66% at 6 months and decreased to 30–44% at 12 months. For SERMs, the proportion of persistent users at 6 months was 40–73% and decreased to 25–59% at 12 months. For parenteral treatment groups, the proportions of persistence with denosumab were 50–85% (6 month), 30–63% (12 month) and with teriparatide 40–75% (6 month) decreasing to 21–54% (12 month). Switching occurred most frequently in the alendronate group (2.8–5.8%) and in the teriparatide group (7.1–14%). Switching typically occurred in the first 6 months and decreased over time. Patients in the alendronate group most often switched to other oral or intravenous bisphosphonates and denosumab.


Our results show suboptimal persistence to medications that varied across different databases and treatment switching was relatively rare.

Original languageEnglish
Pages (from-to)1771-1781
Number of pages11
JournalOsteoporosis International
Issue number10
Publication statusPublished - Oct 2023

Bibliographical note

Funding Information:
This study was funded by UCB Biopharma SRL and Amgen Inc in the context of a post-authorization safety study (PASS) requested by the European Medicines Agency. The study was performed in line with the ENCePP Code of Conduct. The authors had complete autonomy in the process of establishing the protocol, carrying out the analyses, and interpreting the results and retained the full right to publish the results without limitation.

Publisher Copyright:
© 2023, The Author(s).


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