Trends and prescribing patterns of antiosteoporosis medicines in Chinese patients: a real-world retrospective study

BACKGROUND: The availability of new anti-osteoporosis medications (AOMs) and updates to clinical guidelines in recent years may have substantially influenced real-world prescribing patterns. AIMS: To assess trends in the utilization, prescribing patterns of AOMs and related influencing factors in Eastern China. METHODS: Patients with osteoporosis who had at least one prescription for AOMs were identified from a provincial healthcare database in Eastern China (2019–2024). Patients were followed until the occurrence of Paget’s disease, malignant tumors, death, loss to follow-up, or October 29, 2024. The prescribing patterns and utilization trends of AOMs were analyzed. Multivariate logistic regression was performed to identify factors influencing AOMs choice. RESULTS: A total of 363,529 patients were included (mean age 65.1 years; 73.0% female). Active vitamin D analogs (71.9%), bisphosphonates (22.0%), traditional Chinese medicine (TCM) (15.3%) and denosumab (14.2%) were the most commonly prescribed AOMs. The use of denosumab increased significantly (2.9% vs. 21.8%, P < 0.001), while active vitamin D analogs (80.0% vs. 64.8%, P < 0.001), bisphosphonate (26.9% vs. 16.7%, P < 0.001) and TCM (15.3% vs. 11.6%, P < 0.001) declined from 2019 to 2024. Most patients received monotherapy (92.2%), with only 7.8% receiving combination therapy. The most frequent combination was vitamin D and analogs with bisphosphonates (55.6%). Women, older adults, and those with fracture history were more likely to receive calcitonin and denosumab, but less likely to receive vitamin D analogs. CONCLUSIONS: Osteoporosis treatment was predominantly monotherapy, with active vitamin D analogs being the most commonly prescribed agents, followed by bisphosphonates, TCM, and denosumab. Attention should be given to weak evidence-based TCM use.