Timeliness of Antiresorptive Consolidation After Anabolic Therapy for Primary Fracture Prevention: A U.S. Cohort Study.

Abstract

Osteoanabolic therapy for osteoporosis should be followed by antiresorptive treatment ("consolidation") to preserve bone mass. Although osteoanabolic therapy is increasingly endorsed for primary fracture prevention, real-world implementation of consolidation remains unknown. To assess patterns and predictors of timely consolidation after osteoanabolic therapy for primary fracture prevention. Retrospective cohort study. U.S. commercial, Medicare Advantage, and traditional Medicare claims. Adults ≥50 years initiating romosozumab, teriparatide, or abaloparatide between 2011-2022. The primary outcome was timely consolidation-antiresorptive initiation within 3 months of osteoanabolic completion (≥12 months of treatment with romosozumab, ≥18 months with teriparatide/abaloparatide). Secondary outcomes were delayed consolidation (>3-month gap), osteoanabolic restart after a gap, and no consolidation. Multivariable logistic regression identified predictors. Among 15,389 patients (mean age 70.6 years; 89% women; 85% White), 30% completed osteoanabolic therapy (median, 12.9 months for romosozumab; 23.4 months for teriparatide/abaloparatide). Overall, 25% had timely consolidation, 24% delayed consolidation, 12% restarted osteoanabolics, and 40% had no consolidation; only 12% completed therapy with timely consolidation. Timely consolidation was more likely with endocrinology (OR 1.31; 95% CI, 1.17-1.48) or rheumatology (OR 1.45; 1.30-1.62) versus primary care, and less likely among patients aged 50-64 years (OR 0.67; 0.58-0.77) versus 65-74, those enrolled in Medicare Advantage (OR,0.85; 0.74-0.98) versus traditional Medicare, or those recently hospitalized (OR 0.88; 0.80-0.97). Odds increased over time (OR 4.27; 3.63-5.05 for 2021 vs. 2011 starts). Administrative data lack clinical context. Only 1 in 4 patients received timely consolidation therapy after osteoanabolic treatment, and 1 in 8 completed the full sequence. Strategies to improve consolidation in primary fracture prevention are needed.