Archives of Osteoporosis ( IF 3.1 ) Pub Date : 2022-07-19 , DOI: 10.1007/s11657-022-01139-0 Leon Smith 1 , Stephen Wilson 1
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Summary
Trends in bone mineral density monitoring, and drug treatment for osteoporosis, in Australia were examined. Rates of DEXA scanning have increased in response to changes to government policy affecting reimbursement. The drug denosumab is being utilised at an increasing rate, while bisphosphonate use has declined. Osteoporosis prevalence remained stable over the same timeframe, while rate of hip fractures declined, suggesting that introduction of osteoporosis screening was associated with a reduction in adverse osteoporosis outcomes, but may also have been associated with overutilisation.
Introduction
Radiology interventions to diagnose and medications to manage osteoporosis in Australia are reimbursed under the Medicare benefits schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Monitoring of these databases enables changes in utilisation of these practices to be monitored over time.
Methods
This study examined rates of utilisation for bone mineral density (BMD) measurement and osteoporosis pharmacotherapy subsidised under the MBS. Rates of osteoporosis and hip fracture were estimated using data reported by the Australian Bureau of Statistics (ABS) and Australian Institute for Health and Welfare (AIHW).
Results
Rates of BMD measurement increased since the technology was first reimbursed, with changes to policy regarding reimbursement for screening for individuals over 70 leading to an increase in BMD measurement after 2007. Prescribing rates also increased over time, initially with the introduction of oral bisphosphonates and subsequently for denosumab, which has subsequently become the most commonly prescribed agent for osteoporosis management in Australia, while bisphosphonate use has declined. Osteoporosis prevalence in Australia has remained relatively static at 3–4% of the population since 2001 to 2017, while rates of minimal trauma hip fracture hospitalisations have declined from 195 per 100,000 to 174 per 100,000 in the same timeframe.
Conclusion
Available data indicates that osteoporosis screening rates changed over time from 2001 to 2018 and that changes to government policy had a significant effect on the rates at which screening was performed. Over the same timeframe, there was a sustained reduction in hip fracture hospitalisation rates, with no change to reported osteoporosis prevalence. This suggests that policy changes permitting unlimited access to BMD measurement were associated with a reduction in osteoporotic fractures, but may also have been associated with overutilisation. Prospective studies to assess the efficacy of specific policies to ensure screening is performed in accordance with best-practice guidelines may be desirable.
中文翻译：
澳大利亚骨质疏松症诊断和管理的趋势
概括
研究了澳大利亚骨密度监测和骨质疏松症药物治疗的趋势。由于影响报销的政府政策发生变化，DEXA 扫描率有所提高。地诺单抗药物的使用率正在增加，而双膦酸盐的使用率有所下降。骨质疏松症患病率在同一时间段内保持稳定，而髋部骨折率下降，这表明引入骨质疏松症筛查与骨质疏松症不良后果的减少有关，但也可能与过度使用有关。
介绍
在澳大利亚，根据医疗保险福利计划 (MBS) 和药物福利计划 (PBS) 报销用于诊断的放射学干预和用于管理骨质疏松症的药物治疗。对这些数据库的监控可以随着时间的推移监控这些实践的使用变化。
方法
本研究调查了 MBS 资助的骨密度 (BMD) 测量和骨质疏松症药物治疗的利用率。使用澳大利亚统计局 (ABS) 和澳大利亚健康与福利研究所 (AIHW) 报告的数据估算骨质疏松症和髋部骨折的发生率。
结果
自该技术首次报销以来，BMD 测量率有所提高，随着 70 岁以上人群筛查报销政策的变化导致 2007 年后 BMD 测量值增加。处方率也随着时间的推移而增加，最初是随着口服双膦酸盐的引入，随后对于狄诺塞麦，它随后成为澳大利亚最常用的治疗骨质疏松症的处方药，而双膦酸盐的使用有所下降。自 2001 年至 2017 年以来，澳大利亚的骨质疏松症患病率一直保持相对稳定，占人口的 3-4%，而同一时间段内，轻微创伤性髋部骨折住院率从每 100,000 人 195 人下降到每 100,000 人 174 人。
结论
现有数据表明，从 2001 年到 2018 年，骨质疏松症筛查率随时间发生变化，政府政策的变化对筛查率产生了重大影响。在同一时间段内，髋部骨折住院率持续下降，报告的骨质疏松症患病率没有变化。这表明允许无限制地进行 BMD 测量的政策变化与骨质疏松性骨折的减少有关，但也可能与过度使用有关。可能需要进行前瞻性研究来评估特定政策的有效性，以确保根据最佳实践指南进行筛查。
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