(064) Battle of the Bisphosphonates: Global Utilization Trends for Osteoporosis between 2011 and 2022

Background: Bisphosphonates (BPs) are first-line therapy for osteoporosis. Although BPs have been the primary osteoporosis therapy since the 1990s, our understanding of the global patterns of BP utilization is limited.

Objectives: To compare the relative utilization of different BPs for osteoporosis within and across countries over time.

Methods: Quarterly BP purchasing data from April 2011 to September 2022 were obtained from the IQVIA MIDAS database. The analysis was restricted to BPs with doses indicated for osteoporosis: alendronate, etidronate, ibandronate, minodronate, risedronate, and zoledronic acid. We included countries based on a prior scoping review of studies that leveraged healthcare administrative data to estimate real-world evidence of drug effects on fracture risk: Australia, Canada, France, Germany, Italy, Japan, Netherlands, South Korea, Spain, Sweden, Taiwan, the United Kingdom (UK), and the United States (US). Purchasing data were adjusted for the number of days covered by each BP dose based on country-specific dosage regimens for osteoporosis. We estimated the trends in relative BP use by calculating the proportion of annual purchases for each BP by country using the adjusted data.

Results: Alendronate was the most common BP in all countries except Australia, Canada, and South Korea, where risedronate was the most purchased oral BP. Only 5 countries (Australia, Canada, Germany, Sweden, and the UK) had etidronate purchases, which stopped by 2019. Minodronate purchasing grew rapidly following market entry in Japan in 2009 and became proportionally equal to alendronate and risedronate purchases by 2016. Oral ibandronate accounted for ≤10% of total BP purchases in 2022 in all countries where it was available for osteoporosis. Intravenous ibandronate was used primarily for osteoporosis only in Asian countries, where its use steadily increased. In particular, intravenous ibandronate was the most purchased BP in South Korea since 2017, reaching 40% in 2022. Zoledronic acid purchases were <10% in most countries, yet grew gradually, notably in Taiwan to >40% since 2018.

Conclusions: Oral BPs are preferred over intravenous BPs globally except in Taiwan and South Korea. Variations in BP drug use across countries yield unique opportunities to study drug effects. Multinational collaborative research is encouraged to estimate the benefits, safety, and healthcare implications of different BPs and regimens. Moreover, a better understanding of possible exposure patterns may facilitate coordinated proposals for multi-country research to study the relative effects of BP drugs.