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Stakeholder Insight: Osteoporosis - Generic alendronate further establishes oral bisphosphonates as gold standard

Datamonitor
October 7, 2008
199 Pages - SKU: DFMN1926026

Abstract Table of Contents Related Reports

The most important factors that physicians consider when prescribing drugs for osteoporosis are efficacy on bone mineral density and fracture risk reduction. Bisphosphonates reached similar scores on efficacy and safety in Datamonitor's physician survey, but are differentiated in terms of cost, flexibility of administration, and intermittent dosing

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ABOUT DATAMONITOR HEALTHCARE: About the Women's Health pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY: Scope of the analysis; Datamonitor insight into the osteoporosis market; Contributing experts; Related reports
CHAPTER 2 COUNTRY TREATMENT TREES: Introduction to treatment trees; US; Japan; France; Germany; Italy; Spain; UK
CHAPTER 3 DISEASE BACKGROUND AND EPIDEMIOLOGY: Disease background; Osteoporosis classification: primary and secondary; Patient segmentation; Severity: osteopenia, osteoporosis and severe/established osteoporosis; Gender; Ethnicity; Osteoporosis in children; Niche populations with osteoporosis; Epidemiology; Methodological difficulties in assessing prevalence; Differences in the definition of osteopenia, osteoporosis, severe/established osteoporosis and vertebral fractures; Disparities in the reference points (T-score) used for bone mineral density measurement; Differences in the skeletal sites scanned to measure bone mineral density and diagnose osteoporosis; Patient populations include different age groups; Prevalence of osteopenia, osteoporosis and severe/established osteoporosis in postmenopausal women; US; Japan; France; Germany; Italy; Spain; UK; Ageing population expands osteoporosis patient potential
CHAPTER 4 PRESENTATION, DIAGNOSIS AND TREATMENT RATES: Presentation; Similar number of patients are diagnosed after screening as those presenting with a fracture; Initial presentation is most often with a specialist in an out-patient hospital setting; There is not one particular reason most common for presentation; Diagnosis; Under-diagnosis is a major problem in osteoporosis; Patients are most often diagnosed by a specialist in the out-patient setting; The combination of primary assessment and additional diagnostic techniques to achieve an osteoporosis diagnosis is underused; Patient history and physical exam are the most important parts of primary assessment; Dual-energy X-ray absorptiometry (DXA) of the spine/hip is most widely used additional diagnostic technique; Treatment rates; Treatment rates have been increasing but are still low; Guidelines base initiation of pharmacological treatment on cost-effectiveness; The US National Osteoporosis Foundation guidelines on the prevention and treatment of osteoporosis; The European Guidance for the diagnosis and management of osteoporosis in postmenopausal women; The UK National Institute of Clinical Excellence guidelines on primary and secondary prevention of fractures; The German Dachverband Osteologie guideline osteoporosis in women after menopause and in men after age 60; The use of pharmacological treatment increases with disease severity; Type of physician responsible for initial and long-term treatment varies per country; Most patients treated by specialists are treated in the out-patient setting
CHAPTER 5 TREATMENT OPTIONS AND TRENDS: Non-pharmacological treatment of osteoporosis; Overview of the available drug classes; Bisphosphonates; Bisphosphonate combinations; Selective estrogen receptor modulators (SERMs); Parathyroid hormone (PTH) and analogs; Calcitonins; Dual action bone agents (DABAs); Hormone replacement therapy (HRT); Vitamin D; Guidelines often favor bisphosphonates as first-line therapy but do not give detailed recommendations; The European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women; The National Institute for Health and Clinical Excellence (NICE) guidelines for the primary prevention of fractures; The National Institute for Health and Clinical Excellence (NICE) guidelines for the secondary prevention of fractures; The German Dachverband Osteologie (DVO) guidelines; The guidelines published by the National Osteoporosis Foundation (NOF); Trends in pharmacological treatment; Compliance is an important issue in the treatment of osteoporosis; Trends in first-line treatment; Oral bisphosphonates dominate all severities across the seven major markets; Injectable bisphosphonates are mainly reserved for most severe disease; Selective estrogen receptor modulators (SERMs) are most often prescribed in osteopenia; Parathyroid hormones (PTHs) are most often prescribed in severe osteoporosis; Calcitonins are still prominent in Japanese treatment regimens; Strontium ranelate particularly popular in France, Italy and Spain; Reasons to switch to second-line treatment; Trends in second-line treatment; Entry of generic alendronate in the US and Japan
CHAPTER 6 PRESCRIBING INFLUENCES AND BRAND ASSESSMENT: Factors influencing physician decision making; Physician perception of key brands; Total scores per drug per country; Interpreting a brand map; The bisphosphonate class; Bisphosphonates brand map; Bisphosphonates individual scores; Bisphosphonates treatment trends; Overview of key brands; The selective estrogen receptor modulator (SERM) class; Selective estrogen receptor modulator (SERM) brand map; Selective estrogen receptor modulator (SERM) individual scores; Selective estrogen receptor modulator (SERM) treatment trends; Overview of key brands; Products from other drug classes; Products from other drug classes brand map; Products from other drug classes individual scores; Products from other drug classes prescribing trends; Overview of key brands
BIBLIOGRAPHY: Articles; Websites; Press releases
APPENDIX A: Physician research methodology; Physician sample breakdown; US; Japan; France; Germany; Italy; Spain; UK; Contributing experts
APPENDIX B: The survey questionnaire; Section 1 - Patient Segmentation; Section 2 - Presentation and diagnosis; Section 3 - Treatment options; Section 4 - Treatments; Section 5 - Product Profiles; Section 6 -Generic Erosion; About Datamonitor; About Datamonitor Healthcare; About the Women's Health and Urology analysis team; Disclaimer
List of Tables: Table 1: Niche populations with osteoporosis; Table 2: Overview of studies estimating the prevalence of osteopenia in the seven major markets, 2008; Table 3: Overview of studies estimating the prevalence of osteoporosis in the seven major markets; Table 4: Overview of studies estimating the prevalence of severe/established osteoporosis in the seven major markets; Table 5: Prevalence of osteopenia in postmenopausal women across the seven major markets, 2008; Table 6: Prevalence of osteoporosis in postmenopausal women across the seven major markets, 2008; Table 7: Prevalence of severe/established osteoporosis in postmenopausal women across the seven major markets, 2008; Table 8: Overview of the postmenopausal patient populations across the seven major markets with each severity of osteoporosis, 2008; Table 9: Osteoporosis management of hip fracture patients by study site in the US; Table 10: Guideline recommendations on when to initiate pharmacological treatment of osteoporosis, 2008; Table 11: Overview of level of evidence for three bisphosphonates in the primary and secondary prevention of fractures in postmenopausal osteoporosis; Table 12: Overview of the key bisphosphonates available for osteoporosis (sales are osteoporosis-specific), 2008; Table 13: Overview of the key bisphosphonate combinations available for osteoporosis (sales are osteoporosis-specific), 2008; Table 14: Overview of the only selective estrogen receptor modulators (SERM) available for osteoporosis (sales are osteoporosis-specific), 2008; Table 15: Overview of the key parathyroid hormone (PTH) and analogs available for osteoporosis (sales are osteoporosis-specific), 2008; Table 16: Overview of the key calcitonins available for osteoporosis (sales are osteoporosis-specific), 2008; Table 17: Overview of the only dual action bone agent available for osteoporosis in the seven major markets, 2008; Table 18: First-line recommendations of a selection of osteoporosis guidelines, 2008; Table 19: Anti-fracture efficacy of the most frequently used treatments for postmenopausal osteoporosis when given with calcium and vitamin D, as derived from randomized controlled trials; Table 20: Number and percentage of physicians able to rate each osteoporosis drug, 2008; Table 21: Total scores (out of 100) of each osteoporosis drug for each of the individual seven major markets; Table 22: US physician sample breakdown, 2008; Table 23: Japan physician sample breakdown, 2008; Table 24: France physician sample breakdown, 2008; Table 25: Germany physician sample breakdown, 2008; Table 26: Italy physician sample breakdown, 2008; Table 27: Spain physician sample breakdown, 2008; Table 28: UK physician sample breakdown, 2008
List of Figures: Figure 1: US treatment tree, 2008; Figure 2: Japan treatment tree, 2008; Figure 3: France treatment tree, 2008; Figure 4: Germany treatment tree, 2008; Figure 5: Italy treatment tree, 2008; Figure 6: Spain treatment tree, 2008; Figure 7: UK treatment tree, 2008; Figure 8: Osteoporotic fractures occur most commonly at the spine, hip and wrist; Figure 9: World Health Organization classification of osteoporotic bone loss; Figure 10: Average prevalence according to osteoporosis severity across the seven major markets, 2008; Figure 11: Average age at diagnosis for each severity of osteoporosis across the seven major markets, 2008; Figure 12: Rising percentage of women over 50 years of age in the seven major markets, 2008 and 2020; Figure 13: Different routes of diagnosis: screening and presenting with a fracture - average across the seven major markets, 2008; Figure 14: Percentage of patients who present initially to each type of physician, 2008; Figure 15: Percentage of patients who present initially to a specialist in each location, 2008; Figure 16: Percentage of osteopenic and osteoporotic patients who present for each reason, 2008; Figure 17: Percentage of patients who are diagnosed by each type of physician, 2008; Figure 18: Percentage of patients who are diagnosed by a specialist in each location, 2008; Figure 19: Use of each method of patient assessment by PCPs/GPs and specialists in order to reach osteoporosis diagnosis, 2008; Figure 20: Potentially osteoporotic patients who receive each method of primary assessment, 2008; Figure 21: Potentially osteoporotic patients who receive each method of additional diagnostic technique, 2008; Figure 22: Advantages of central dual-energy X-ray absorptiometry (DXA); Figure 23: Treatment of Caucasian women aged 60 years or older with osteoporosis or vertebral fractures by primary care physicians, by drug type, 1993-97; Figure 24: Management algorithm in postmenopausal women based on an health economic analysis for the UK, 2008; Figure 25: Osteopenic, osteoporotic and severe/established osteoporotic patients receiving each type of treatment, 2008; Figure 26: Percentage of patients who are treated (initially and long-term) by each type of physician, 2008; Figure 27: Percentage of patients who are treated by a specialist in each

Stakeholder Insight: Osteoporosis - Generic alendronate further establishes oral bisphosphonates as gold standard

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