Multidisciplinary Endocrinology and Pharmacy Approach to Anabolic Therapy Initiation for Patients with Osteoporosis

Anabolic therapy with teriparatide and abaloparatide has been increasingly used to treat osteoporosis. There have been challenges in terms of adherence to these agents. Patients need to be counseled regarding correct injection technique and high cost can be a barrier to initiation. Studies have shown improvement in insulin adherence in patients with diabetes who participated in a patient education program. We aimed to improve adherence with anabolic osteoporosis medications by initiating a multidisciplinary patient education program.

Methods:

Patients were evaluated by an Endocrinologist who determined whether they met indication for anabolic therapy. AACE guidelines recommend initiating anabolic therapy in post-menopausal women with osteoporosis at high risk of fractures. Patients who met criteria were referred to a pharmacist. At initial visit, the pharmacist helped obtain prior authorization, provided teaching about injection technique, and counseled regarding adverse reactions. At 1 month follow up, she confirmed adherence via proportion of days covered (PDC), a validated pharmacy metric, and assessed whether monitoring labs were completed. The patients then followed up with their Endocrinologist in 3-6 months where adherence and tolerability were again assessed. Statistical analyses were performed using Stata version 17.

Results:

This program began in October 2020 with 31 participants receiving patient education within 12 months of initiation. Participants were on average 67 years old (81% female and 76% white). 93% of patients met osteoporosis diagnosis and 83% had a prior fracture. All patients except one received insurance coverage of teriparatide/abaloparatide with 4 participants benefiting from the Medicare Part D Copay Waiver. 90% of participants were adherent, which is defined as PDC greater than 80%. Only 12% of patients discontinued therapy despite 22% of patients experiencing side effects. The most common side effect was lightheadedness. 65% of participants had labs completed at Endocrinology follow up visit, with none found to be hypercalcemic on therapy.

Discussion/Conclusion:

Implementing a patient education program helped patients gain access to teriparatide/abaloparatide, provide injection training, and improved medication adherence. A strength of this program is identifying patients who need financial assistance and helping them obtain prior authorization in a timely manner. Another strength is the assessment of adherence using pharmacy dispensing records rather than patient-reported adherence. Notably, our program’s adherence rate is higher than 61% reported in the literature. Future steps include implementing this program at an affiliated medical center.