Denosumab Was the Most Frequently Initiated Osteoporosis Drug in 2018, ACR Study Finds


The results of a study presented at ACR 2020 demonstrate that a greater proportion of patients were initiated on denosumab compared with bisphosphonates for the first time—18.5% compared with 16.9%— in 2018.

A smaller proportion of patients are being initiated on new osteoporosis medications but, for the ones who are, denosumab is the drug rheumatologists choose to prescribe most often, not bisphosphonates, investigators reported at the annual meeting of the American College of Rheumatology in November.

Many treatments are available for osteoporosis treatment, but how rheumatologists choose to make use of these treatments has not been well understood. The Rheumatology Informatics System for Effectiveness (RISE) is an electronic health record (EHR)-enabled registry developed by the American College of Rheumatology to facilitate quality improvement among rheumatology practices, and has enabled researchers to examine patterns of osteoporosis medication utilization among rheumatologists reporting to it.

In December 2018, RISE held data from 715 rheumatology providers in 226 practices, or from approximately a fifth of the US clinical rheumatology workforce.

Data on all patients aged at least 18 years for whom there was at least 1 diagnostic code for osteoporosis or prescriptions of osteoporosis medications every year between 2015 and 2018 were identified. This amounted to 251,620 eligible patients from 217 practices, of which 89.6% were female, 68.4% were white, 4.5% were black, and 7.5% were identified as Hispanic or Latino. Patients had a mean age of 73.0 +/- 11.3 years. The most common co-morbid autoimmune rheumatic disease was rheumatoid arthritis, and 11.9% of the patients had the disease.

Both overall osteoporosis medication use and new osteoporosis medication initiations were looked at for each calendar year.

Nitasha Khullar, MD

“Osteoporosis medication initiation in rheumatology practices declined over 2015-2018, however denosumab treatment appears to be gaining popularity," study co-author Nitasha Khullar, MD, of the University of Alabama at Birmingham, said. "Bisphosphonate therapy remains favored as first line therapy for osteoporosis, but overall denosumab was initiated more frequently in 2018 compared to bisphosphonate therapy or anabolics.”

The results showed that in 2018 a greater proportion of patients were initiated on denosumab compared with bisphosphonates for the first time—18.5% compared with 16.9%. This is the first time that denosumab has overtaken bisphosphonates as the most popular osteoporosis drug initiation.

Around a third of the patients initiated denosumab appeared to have been switched from bisphosphonates; in 2018, 34.6% had a prior recorded history of being on bisphosphonate therapy. In comparison only 9.0% of patients that started bisphosphonates in 2018 had a prior recorded history of receiving denosumab previously.

In patients who were naïve to osteoporosis therapy, bisphosphonates remained the most frequently prescribed first-line treatment in 2018.

Between 2015 and 2018 there was a decline in the proportion of registry participants initiating osteoporosis medications in each calendar year, despite an increasing number of eligible patients in the registry; in 2015, 47.9% of patients initiated osteoporosis treatment, and this fell to 42.1% in 2016, 40.5% in 2017, and 36.5% in 2018.


Khullar N, Chen L, Curtis J, et al. Osteoporosis medication utilization patterns over time in the ACR RISE registry. Presented at: American College of Rheumatology Convergence 2020; November 5-9, 2020; Virtual. Accessed November 8, 2020.

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