Management of osteoporosis with PTH: treatment and prescription patterns in Europe

Background: PTH is an anabolic agent that promotes new bone formation and offers additional therapeutic options for the treatment of postmenopausal osteoporosis. Two forms of PTH are licensed for treatment of postmenopausal osteoporosis and are available in most European countries. Both demonstrate safety and efficacy in clinical trials with similar increases in bone mineral density (BMD) at the spine, total hip and femoral neck, and reductions in the number of vertebral fractures in postmenopausal women. The effect on the number of patients treated with PTH is analysed in terms of the total number of osteoporotic patients and total number of eligible patients, as defined by a literature review of vertebral fracture incidence in European populations. Aims: To analyse the management and treatment of postmenopausal osteoporosis with PTH in terms of the prescription patterns for PTH in five European countries and the underlying reasons for observed rates of prescription in each country. Findings: Osteoporosis patients with low vertebral BMD and two fractures are at appreciable risk of sustaining further fractures, particularly hip fractures. Hip fractures are associated with significant mortality and huge economic cost to society. These patients are approved for treatment with PTH but the availability of this therapy varies considerably across Europe. The number of patients receiving PTH varies from 0.24% of eligible patients in the UK to approximately 5% of eligible patients in Spain. Conclusion: Large differences (up to 20-fold) exist in the number of patients receiving PTH across the five European countries. The reasons for the different accessibility to PTH arise from a combination of restrictive schedules of reimbursement, high cost and lack of knowledge of the potential benefits of PTH by physicians.