Direct health-care costs attributed to hip fractures among seniors: a matched cohort study

Summary

Using a matched cohort design, we estimated the mean direct attributable cost in the first year after hip fracture in Ontario to be $36,929 among women and $39,479 among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada.

Introduction

Osteoporosis is a major public health concern that results in substantial fracture-related morbidity and mortality. It is well established that hip fractures are the most devastating consequence of osteoporosis, yet the health-care costs attributed to hip fractures in Canada have not been thoroughly evaluated.

Methods

We determined the 1- and 2-year direct attributable costs and cost drivers associated with hip fractures among seniors in comparison to a matched non-hip fracture cohort using health-care administrative data from Ontario (2004–2008). Entry into long-term care and deaths attributable to hip fracture were also determined.

Results

We successfully matched 22,418 female (mean age?=?83.3 years) and 7,611 male (mean age?=?81.3 years) hip fracture patients. The mean attributable cost in the first year after fracture was $36,929 (95 % CI $36,380–37,466) among women and $39,479 (95 % CI $38,311–$40,677) among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada. Primary cost drivers were acute and post-acute institutional care. Approximately 24 % of women and 19 % of men living in the community at the time of fracture entered a long-term care facility, and 22 % of women and 33 % of men died within the first year following hip fracture. Attributable costs remained elevated into the second year ($9,017 among women, $10,347 among men) for patients who survived the first year.

Conclusions

We identified significant health-care costs, entry into long-term care, and mortality attributed to hip fractures. Results may inform health economic analyses and policy decision-making in Canada.     

Two-year cost comparison of vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: are initial surgical costs misleading?

Summary

The costs for treating kypho- and vertebroplasty patients were evaluated at up to 2 years postsurgery. There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8–7.9 % in the remaining periods through 2 years postsurgery.

Introduction

Vertebral augmentation has been shown to be safe and effective for treating vertebral compression fractures. Comparative cost studies of initial treatment costs for kypho- and vertebroplasty have been mixed. The purpose of our study was to compare the costs for treating kypho- and vertebroplasty patients at up to 2 years postsurgery.

Methods

Vertebroplasty and kyphoplasty patients diagnosed with pathologic or closed lumbar/thoracic vertebral fractures were identified from the 5 % sample of the Medicare dataset (2006–2009). The final study cohort with at least 2 years follow-up comprised of 1,609 vertebroplasty and 2,878 kyphoplasty patients. The cumulative treatment costs (adjusted to June 2011 US$) were determined from the payer perspective. Differences in costs and length of stay were assessed by generalized linear mixed model regression, adjusting for covariates.

Results

The average adjusted costs for vertebroplasty patients within the first quarter and the first 2 years postsurgery were $14,585 [95 % confidence interval (CI), $14,109–15,078] and $44,496 (95 % CI, $42,763–46,299), respectively. The corresponding average adjusted costs for kyphoplasty patients were $15,117 (95 % CI, $14,752–15,491) and $41,339 (95 % CI, $40,154–42,560). There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8–7.9 % in the remaining periods through 2 years postsurgery.

Conclusion

Our present study addresses some of the limitations in previous comparative cost studies of vertebroplasty and kyphoplasty. The higher adjusted costs for vertebroplasty patients than kyphoplasty patients by 1 year following the surgery reflect greater utilization of medical resources.     

Single-site Laparoscopic Colorectal Surgery Provides Similar Lengths of Hospital Stay and Similar Costs Compared with Standard Laparoscopy: Results of a Retrospective Cohort Study

Background

The present study sought to compare the length of stay (LOS) and hospital costs for elective single-site (SSL) and standard laparoscopic (SDL) colorectal resections performed at a tertiary referral center.

Methods

An IRB-approved, retrospective cohort study of all elective SDL and SSL colorectal resections performed from 2008 to 2012 was undertaken. Patient charges and inflation adjusted hospital costs (US dollars) were compared with costs subcategorized by operating room expense, room and board, and pharmacy and radiology utilization.

Results

A total of 149 SDL and 111 SSL cases were identified. Compared with SSL, SDL surgeries were associated with longer median operative times (SSL: 153 min vs. SDL: 189 min, p?=?0.001); however, median operating room costs were similar (p?>?0.05). Median postoperative LOS was similar for both groups (SSL: 3 days; SDL: 4 days; p?>?0.05). There was no difference between SSL and SDL with respect to either total patient charges (SSL: $34,847 vs. SDL: $38,306; p?>?0.05) or hospital costs (SSL: $13,051vs. SDL: $12,703; p?>?0.05). Median costs during readmission were lower for SSL patients (SSL: $3,625 vs. SDL: $6,203, p?=?0.04).

Conclusions

SSL provides similar LOS as well as similar costs to both patients and hospitals compared with SDL, making it a cost-feasible alternative.     

An algorithm using the early changes in PINP to predict the future BMD response for patients treated with daily teriparatide

Summary

About two thirds of patients with a procollagen type I N-terminal propeptide (PINP) increase of >80 μg/l at 1 month after starting teriparatide therapy showed a ≥10 % increase in lumbar spine (LS) bone mineral density (BMD) from baseline at 12 months. We recommend this algorithm as an aid in the clinical management of patients treated with daily teriparatide.

Introduction

An algorithm using PINP is provided in osteoporotic patients with teriparatide treatment. The correlations between the early changes in PINP and the subsequent BMD changes after daily teriparatide therapy were studied to develop an algorithm to monitor patients.

Methods

We evaluated whether early changes in PINP correlated with the changes in BMD at 12 months and developed an algorithm using the early changes in PINP to predict the upcoming BMD increases.

Results

The highest correlation coefficient for the relationship between PINP and LS BMD response was determined for the absolute change in PINP at 1 month and the percent change in LS BMD at 12 months (r?=?0.36, p <0.01). Using a receiver operator curve analysis, we determined that an 80 μg/l increase in PINP was the most convenient predictor of a 10 % increase in LS BMD from baseline (area under curve?=?0.72). Using a cut-off value of 80 μg/l, the positive predictive value for predicting a 10 % increase in LS BMD from baseline to 12 months was 65 %.

Conclusion

Greater short-term changes in PINP with teriparatide therapy are associated with greater 12-month increases in LS BMD. About two thirds of patients with a PINP increase of >80 μg/l at 1 month after starting treatment showed a ≥10 % increase in LS BMD from baseline at 12 months. We recommend this algorithm as an aid in the clinical management of patients treated with teriparatide.     

Application of ACOSOG Z0011 Criteria Reduces Perioperative Costs

Background

The ACOSOG Z0011 (Z0011) trial concluded that sentinel lymph node biopsy (SLNB) without completion axillary lymph node dissection (ALND) provides excellent regional control in women with T1–T2 sentinel lymph node (SLN) positive breast cancers receiving breast conservation therapy. We determined whether application of Z0011 guidelines would reduce costs.

Methods

A retrospective chart review of patients with invasive breast cancer treated with lumpectomy and SLNB at our institution during 2009 was performed. We determined the number of overnight hospital admissions following ALND and estimated costs pertaining to the perioperative surgical management of the axilla patients actually received, and compared those to the estimated number of inpatient days and perioperative costs if Z0011 guidelines had been followed for eligible patients. The 2011 Medicare Fee Schedule was used to estimate costs for procedures, and costs for OR time were estimated using procedure length and cost of OR time per minute.

Results

A total of 71 patients underwent lumpectomy with SLNB and had at least 1 positive SLN. Estimated costs related to perioperative surgical management of the axilla were $322,775, and there were 36 overnight admissions. Applying Z0011 criteria, 51 patients (72 %) would have been eligible to forego completion ALND. Estimated costs would have been $264,513 with 13 overnight admissions, translating into a cost savings of $58,262 and 23 fewer overnight admissions.

Conclusion

Application of Z0011 guidelines resulted in cost savings, with a 64 % reduction in inpatient hospital days and an 18 % reduction in early perioperative costs.     

Defining High Risk: Cost-Effectiveness of Extended-Duration Thromboprophylaxis Following Major Oncologic Abdominal Surgery

Purpose

Extended-duration thromboprophylaxis (EDTPPX) is the practice of prescribing antithrombotic therapy for 21 days after discharge, commonly used in surgical patients who are at high risk for venothromboembolism (VTE). While guidelines recommend EDTPPX, criteria are vague due to a paucity of data. The criteria can be further informed by cost-effectiveness thresholds. This study sought to determine the VTE incidence threshold for the cost-effectiveness of EDTPPX compared to inpatient prophylaxis.

Methods

A decision tree was used to compare EDTPPX for 21 days after discharge to 7 days of inpatient prophylaxis with base case assumptions based on an abdominal oncologic resection without complications in an otherwise healthy individual. Willingness to pay was set at $50,000/quality-adjusted life year (QALY). Sensitivity analyses were performed to assess uncertainty within the model, with particular interest in the threshold for cost-effectiveness based on VTE incidence.

Results

EDTPPX was the dominant strategy when VTE probability exceeds 2.39 %. Given a willingness to pay threshold of $50,000/QALY, EDTPPX was the preferred strategy when VTE incidence exceeded 1.22 and 0.88 % when using brand name or generic medication costs, respectively.

Conclusions

EDTPPX should be recommended whenever VTE incidence exceeds 2.39 %. When post-discharge estimated VTE risk is 0.88–2.39 %, patient preferences about self-injections and medication costs should be considered.     

Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance

Summary

Adherence to, and persistence with, treatments for osteoporosis are low. Adherence with teriparatide decreases over time. Higher copayments in the commercial/Medicare population were associated with worse persistence. Understanding factors such as prior screening, prior treatment history, and out of pocket costs that influence persistence with teriparatide may help clinicians make informed decisions.

Introduction

The purpose of this study was to evaluate adherence and persistence with teriparatide.

Methods

Beneficiaries with at least one claim for teriparatide in 2003 or 2004 and continuous enrollment in the previous 12?months and subsequent 6?months were identified in a national commercial/Medicare and Medicaid administrative claims database (MarketScan?). Adherence was assessed through calculation of the medication possession ratio (MPR). Persistence was measured by time until discontinuation and time until first 60-day gap in treatment. Factors associated with persistence were assessed using Cox proportional hazards models.

Results

The average MPR at 6?months was 0.74 (N?=?2,218) and at 12?months, was 0.66 (N?=?1,303). At 6?months, 64.6% of patients remained on therapy and at 12?months, 56.7% remained. Bone mineral density screening and use of antiresorptive therapy within the 12?months pre-period, and lower patient copayments were associated with increased persistence.

Conclusion

Patients appear to have good adherence with teriparatide over the first 6?months which declines over time. Prior screening and treatment of osteoporosis and out of pocket costs appear to impact persistence. To optimize patient outcomes, clinicians should consider clinical factors that impact persistence, while healthcare decision makers should consider the negative effect of higher patient copayments on persistence.     

Mediterranean diet and incidence of hip fractures in a European cohort

Summary

Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men.

Introduction

Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries.

Methods

A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders.

Results

Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI)?=?0.89–0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR?=?0.86; 95 % CI?=?0.79–0.94) and high fruit (HR?=?0.89; 95 % CI?=?0.82–0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR?=?1.18; 95 % CI?=?1.06–1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate?=?1.74; 95 % CI?=?1.32–2.31) was also a risk factor.

Conclusions

In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.     

Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection

Background

During the past 20 years, laparoscopy has revolutionized colorectal surgery. With proven benefits in patient outcomes and healthcare utilization, laparoscopic colorectal surgery has steadily increased in use. Robotic surgery, a new addition to colorectal surgery, has been suggested to facilitate and overcome limitations of laparoscopic surgery. Our objective was to compare the outcomes of robot-assisted laparoscopic resection (RALR) to laparoscopic resections (LAP) in colorectal surgery.

Methods

A national inpatient database was evaluated for colorectal resections performed over a 30-month period. Cases were divided into traditional LAP and RALR resection groups. Cost of robot acquisition and servicing were not measured. Main outcome measures were hospital length of stay (LOS), operative time, complications, and costs between groups.

Results

A total of 17,265 LAP and 744 RARL procedures were identified. The RALR cases had significantly higher total cost ($5,272 increase, p < 0.001) and direct cost ($4,432 increase, p < 0.001), significantly longer operating time (39 min, p < 0.001), and were more likely to develop postoperative bleeding (odds ratio 1.6; p = 0.014) than traditional laparoscopic patients. LOS, complications, and discharge disposition were comparable. Similar findings were noted for both laparoscopic colonic and rectal surgery.

Conclusions

RALR had significantly higher costs and operative time than traditional LAP without a measurable benefit.     

Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema

Objective

Phlebolymphedema (chronic venous insufficiency-related lymphedema) is a common and costly condition. Nevertheless, there is a dearth of evidence comparing phlebolymphedema therapeutic interventions. This study sought to examine the medical resource utilization and phlebolymphedema-related cost associated with Flexitouch (FLX; Tactile Medical, Minneapolis, Minn) advanced pneumatic compression devices (APCDs) relative to conservative therapy (CONS) alone, simple pneumatic compression devices (SPCDs), and other APCDs in a representative U.S. population of phlebolymphedema patients.

Estimating the excess costs for patients with incident fractures, prevalent fractures, and nonfracture osteoporosis

Summary

Based on a population age 50+, significant excess costs relative to matched controls exist for patients with incident fractures that are similar in relative magnitude to other chronic diseases such as stroke or heart disease. Prevalent fractures also have significant excess costs that are similar in relative magnitude to asthma/chronic obstructive pulmonary disease.

Introduction

Cost of illness studies for osteoporosis that only include incident fractures may ignore the long-term cost of prevalent fractures and primary preventive care. We estimated the excess costs for patients with incident fractures, prevalent fractures, and nonfracture osteoporosis relative to matched controls.

Methods

Men and women age 50+ were selected from administrative records in the province of Manitoba, Canada for the fiscal year 2007–2008. Three types of cases were identified: (1) patients with incident fractures in the current year (2007–2008), (2) patients with prevalent fractures in previous years (1995–2007), and (3) nonfracture osteoporosis patients identified by specific pharmacotherapy or low bone mineral density. Excess resource utilization and costs were estimated by subtracting control means from case means.

Results

Seventy-three percent of provincial population age 50+ (52 % of all men and 91 % of all women) were included (121,937 cases, 162,171 controls). There were 3,776 cases with incident fracture (1,273 men and 2,503 women), 43,406 cases with prevalent fractures (15,784 men and 27,622 women) and 74,755 nonfracture osteoporosis cases (7,705 men and 67,050 women). All incident fractures had significant excess costs. Incident hip fractures had the highest excess cost: men $44,963 (95 % CI: $38,498–51,428) and women $45,715 (95 % CI: $36,998–54,433). Prevalent fractures (other than miscellaneous or wrist fractures) also had significant excess costs. No significant excess costs existed for nonfracture osteoporosis.

Conclusion

Significant excess costs exist for patients with incident fractures and with prevalent hip, vertebral, humerus, multiple, and traumatic fractures. Ignoring prevalent fractures underestimate the true cost of osteoporosis.     

Rectal Cancer and Teaching Hospitals: Hospital Teaching Status Affects Use of Neoadjuvant Radiation and Survival for Rectal Cancer Patients

Background

For rectal cancer, it is unknown how use of radiation, treatment cost, and survival differ based on hospital teaching designation.

Methods

Private insurance claims data linked with the Pennsylvania Cancer Registry were used to identify rectal cancer patients undergoing surgery from 2004 to 2006. Patients with missing data of interest were excluded. Hospitals were characterized as follows: large (≥200 beds) versus small size (<200 beds), teaching versus nonteaching, and urban versus rural. Logistic regression was used to model the use of neoadjuvant radiotherapy, and Cox proportional hazards models were used to compare cancer-specific survival between hospital types.

Results

A total of 432 patients were analyzed. There was no difference in the distribution of cancer stages among the various hospital types (all p > 0.20). Teaching hospitals were associated with significantly higher utilization of neoadjuvant radiotherapy for stage II and III cancers compared with nonteaching facilities (57 vs. 28 %; p < 0.0001). On multivariate analysis, teaching status was the only hospital designation associated with use of neoadjuvant radiation (p < 0.001); hospital size and rural/urban designation were not significant. Nonteaching hospitals were more likely to use adjuvant radiotherapy for stage II and III disease (13 vs. 30 %; p < 0.01). Teaching hospitals had lower odds of death from rectal cancer when evaluating all stages [hazard ratio (HR) = 0.35; p < 0.0001] with similar costs of inpatient treatment (teaching: US $30,769 versus nonteaching: US $26,892; p = 0.22).

Conclusions

Teaching designation was associated with higher incidence of neoadjuvant radiotherapy for stage II and III disease, with improved cancer-specific survival compared with nonteaching hospitals, and with similar treatment costs.     

Cost and management of males with closed fractures

Summary

The purpose of this study was to examine the medical costs and the management of osteoporosis in the 12 months after a closed fracture for men aged ≥?45 years. The mean medical cost per fracture was high ($6,078–$30,900), and osteoporosis management post fracture was inadequate in the majority of men.

Introduction

This study was conducted in order to examine the medical costs following fracture in males and the management of osteoporosis post fracture.

Methods

Administrative claims from a large, national health plan were analyzed. Men ≥?45 years were included if they had ≥?1 medical claim for a new closed fracture between January 1, 2005 and December 31, 2008. Commercially insured (COM) and Medicare Advantage Plan (MAP) members were analyzed separately. Costs were calculated as paid amounts and adjusted to 2010 dollars. Both the differences between the individual patients’ 12-month pre-fracture and 12-month post-fracture costs and the costs directly attributed to the fracture were reported. The prevalence of dual-energy X-ray absorptiometry (DXA) scan and/or osteoporosis pharmacotherapy treatment was evaluated in the 12 months post fracture.

Results

We identified 18,917 (COM, 16,191; MAP, 2,726) men with new closed fractures. Non-hip, non-vertebral fractures (NHNV) were the most common fracture in both COM and MAP populations. Fracture costs ranged from $7,121 to $15,830 for vertebral fractures, from $22,601 to $30,900 for hip fractures, and from $6,078 to $8,344 for NHNV fractures. In the COM and MAP populations, respectively, 8.5 and 15.5 % had a DXA scan and/or osteoporosis pharmacotherapy in the 12 months following the fracture.

Conclusions

Healthcare costs associated with fractures in men are substantial. About 1 in 12 men ≥?45 years in the COM population were provided adequate follow-up for osteoporosis post fracture. While this rate improved to about one in six men in the MAP population, osteoporosis management in men post fracture is far from optimal.     

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

Objective

Risks of brain surgery in elderly patients with brain metastases are not well defined. This study was designed to quantify the postoperative risk for these patients after brain surgery for metastatic disease to the brain.

Methods

We performed a retrospective analysis of the Nationwide Inpatient Sample (1998–2005). Patients aged 65 years or older who underwent tumor resection of brain metastases were identified by ICD-9 coding. Primary outcome was inpatient death. Other outcomes included systemic postoperative complications, length of stay (LOS), and total charges.

Results

A total of 4,907 patients (53.6% men) were identified. Mean age was 72.1 years. Mean Charlson comorbidity score was 7.8. Inpatient mortality was 4%. The most common adverse events were pulmonary complications (3.4%). Mean length of stay was 9.2 days. Mean total charges were $57,596.39. In multivariate analysis, patients up to age 80 years had no significantly greater odds of inpatient death, relative to their 65- to 69-year-old counterparts. Each 1-point increase in Charlson score was associated with 12% increased odds of death, 0.52 days increased LOS, and $1,710.61 higher hospital charges. Postoperative pulmonary complications, stroke, or thromboembolic events increased LOS and total charges by up to 9.6 days and $57,664.42, respectively. These associations were statistically significant (P < 0.05).

Conclusions

Surgical resection of brain metastases among the elderly up to the ninth decade of life is feasible. Age older than 80 years and higher Charlson comorbidity scores were found to be important prognostic factors for inpatient outcome. Incorporating these factors into preoperative decision making may help to select appropriately those elderly candidates for neurosurgical intervention.     

Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy

Introduction and hypothesis

To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery.

Methods

The study used 2008–2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy’ and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits,

Results

There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82–0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period.

Conclusions

The study using private insurance data found that robot-assisted hysterectomy was associated with higher health resource utilization and costs than other minimally invasive approaches. Given the high costs associated with robot-assisted hysterectomy, it is important to understand the specific indications for this approach and to identify the patients who may benefit.

     

Comparison of the effect of 18-month daily teriparatide administration on patients with rheumatoid arthritis and postmenopausal osteoporosis patients

Summary

Patients with rheumatoid arthritis showed greater response to 18-month administration of daily teriparatide especially in the increase of bone formation markers at 1 month and femoral neck bone mineral density at 18 months compared to postmenopausal osteoporosis patients.

Introduction

The aim of this study was to evaluate the effects of 18-month administration of daily teriparatide (TPTD) in osteoporosis patients with rheumatoid arthritis (RA) by comparing that of postmenopausal osteoporosis patients (Porosis).

Methods

The effects of TPTD were examined between RA (n?=?70; age 68.4 years; disease activity score assessing 28 joints with CRP [DAS28-CRP] 2.8; rheumatoid factor [RF] positivity 75.5 %) with 77.1 % of prior bisphosphonate (BP), 84.3 % of oral prednisolone (PSL) (4.4 mg/day at baseline), 25.7 % of biologics, and Porosis (n?=?62; age 71.3 years) with 77.4 % of prior BP.

Results

Femoral neck (FN) bone mineral density (BMD) increase at 18 months was significantly greater in RA compared to Porosis (4.7 vs. 0.7 %, P?=?0.038), whereas it was 9.7 versus 7.9 % (P?=?0.736) in the lumbar spine (LS). The increase of bone formation markers (bone alkaline phosphatase [bone ALP] and N-terminal type I procollagen propeptide [PINP]) at 1 month were all significantly greater in RA compared to Porosis. A multivariate logistic regression analysis revealed that the significant indicator of 18-month BMD increase in RA was a 3-month increase of under-carboxylated osteocalcin (ucOC) for LS (β?=?0.446, P?=?0.005) and baseline ucOC for FN (β?=?0.554, P?=?0.001), in which both showed significant negative correlation with baseline PSL dose.

Conclusions

RA showed greater response to daily TPTD administration, especially in the increase of bone formation markers at 1 month and FN BMD increase at 18 months compared to Porosis.