Effect of the women's health initiative on prescription anti-osteoporosis medication utilization

Summary: Publication of the Women's Health Initiative (WHI) resulted in a 39% reduction in hormone therapy utilization and a 29% increase in the use of new anti-osteoporosis medications. Overall, the prevalence of prescription anti-osteoporosis medication use declined following the WHI. This has important implications for osteoporosis prevention and treatment. Introduction: Women who discontinued hormone therapy (HT) following the Women's Health Initiative (WHI) may have been more likely to initiate treatment with newer anti-osteoporosis medications (AOM). The objective of this study was to examine the influence of the WHI on AOM utilization among a nationally representative sample of older adult women in the U.S. Methods: We used the Medical Expenditure Panel Survey (MEPS) to examine AOM utilization among women aged 50 years and older. National estimates of AOM utilization were predicted from a sample of 2089 women interviewed five times between 2002 and 2003. AOM utilization was dichotomized for HT and newer AOM. Generalized estimating equations were used to predict odds ratios (OR) for AOM utilization controlling for potential predisposing, enabling, and need confounders. Results: Prior to the WHI, there were 8.7 and 3.6 million U.S. women using HT and newer AOM, respectively. One year following publication of the WHI, 5.3 million HT users persisted [OR 0.638 (95% CI: 0.617, 0.756)] while 4.7 million women used newer AOM [1.337 (95% CI: 1.120, 1.597)]. Conclusions: Although reductions in HT utilization were accompanied by increased utilization of newer AOM, treatment prevalence for osteoporosis remains sub-optimal.