{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:29:35Z","timestamp":1789759775618,"version":"4.0.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2006,5,1]],"date-time":"2006-05-01T00:00:00Z","timestamp":1146441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Decreasing HRT use among postmenopausal women may have a reciprocal impact on other osteoporosis therapy. Time series analysis of prescribing trends for millions of Medicaid beneficiaries revealed a 57% decline in HRT without augmenting the pace of bisphosphonate use. Prescribing changes dramatically increased Medicaid spending on osteoporosis therapy over the last decade and requires further evaluation of cost effectiveness.<\/jats:p>\n               <jats:p>Introduction: Hormone replacement therapy (HRT) has been commonly prescribed to postmenopausal women, but its use is decreasing because adverse cardiac outcomes were reported by the Wome\u0144s Health Initiative (WHI) in July 2002. The reciprocal impact of the WHI on other osteoporosis medications use and expenditure is unknown.<\/jats:p>\n               <jats:p>Materials and Methods: We conducted a time series analysis on prescription data from 50 state Medicaid programs between 1995 and 2004. Five medication categories were used: HRT, bisphosphonates, calcium, calcitonin, and raloxifene.<\/jats:p>\n               <jats:p>Results: HRT was increasing before publication of the WHI, reaching 5 million prescriptions per year by mid-2002 (136 prescriptions per 1000 beneficiaries). Bisphosphonate prescribing rose in parallel until mid-2002. WHI publication was associated with a rapid reduction in HRT use, declining 57% by mid-2004 to an average of 59 prescriptions per 1000 beneficiaries (p = 0.01). WHI publication did not augment bisphosphonates' nearly linear rate of rise (p = 0.43) as their prescribing pace continued, whereas HRT declined. Medicaid spending on osteoporosis therapy also changed dramatically during the last decade, as yearly expenditure increased 664% from $1465 to $9742 per 1000 beneficiaries. Over this period, a significant shift from daily to weekly bisphosphonates also occurred.<\/jats:p>\n               <jats:p>Conclusions: A dramatic decline in HRT and continued rise in bisphosphonate prescribing has occurred since the publication of the WHI. During this time, there have also been substantial increases in osteoporosis medication spending within Medicaid. Determining whether these trends are clinically appropriate and cost effective for osteoporosis therapy will have important implications for the development of future drug reimbursement programs, especially for elderly patients.<\/jats:p>","DOI":"10.1359\/jbmr.060119","type":"journal-article","created":{"date-parts":[[2006,5,30]],"date-time":"2006-05-30T09:19:38Z","timestamp":1148980778000},"page":"765-771","source":"Crossref","is-referenced-by-count":45,"title":["Effect of the Women's Health Initiative on Osteoporosis Therapy and Expenditure in Medicaid"],"prefix":"10.1093","volume":"21","author":[{"given":"Jacob A","family":"Udell","sequence":"first","affiliation":[{"name":"Department of Medicine, Vancouver Hospital and Health Sciences Centre and University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Fischer","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Alan","family":"Brookhart","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niteesh K","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2009,12,4]]},"reference":[{"key":"2024013019390478100_bib1","volume-title":"America's Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation","author":"National Osteoporosis Foundation","year":"2003"},{"key":"2024013019390478100_bib2","doi-asserted-by":"crossref","first-page":"289","DOI":"10.2165\/00019053-200220050-00001","article-title":"Quality-of-life assessment in osteoporosis: Health-status and preference-based measures","volume":"20","author":"Tosteson","year":"2002","journal-title":"Pharmacoeconomics"},{"key":"2024013019390478100_bib3","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1503\/cmaj.1030757","article-title":"Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: Recommendation statement from the Canadian Task Force on Preventive Health Care","volume":"170","author":"Cheung","year":"2004","journal-title":"Can Med Assoc J"},{"key":"2024013019390478100_bib4","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0002-9343(03)00357-7","article-title":"Underuse of osteoporosis medications in elderly patients with fractures","volume":"115","author":"Solomon","year":"2003","journal-title":"Am J Med"},{"key":"2024013019390478100_bib5","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1001\/archinte.163.17.2052","article-title":"Low frequency of treatment of osteoporosis among postmenopausal women following a fracture","volume":"163","author":"Andrade","year":"2003","journal-title":"Arch Intern Med"},{"key":"2024013019390478100_bib6","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1001\/archinte.162.20.2278","article-title":"Osteoporosis and fractures in postmenopausal women using estrogen","volume":"162","author":"Nelson","year":"2002","journal-title":"Arch Intern Med"},{"key":"2024013019390478100_bib7","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s001980050224","article-title":"Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis","volume":"10","author":"Genant","year":"1999","journal-title":"Osteoporos Int"},{"key":"2024013019390478100_bib8","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1001\/jama.285.6.785","article-title":"Diagnosis, and Treatment. 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