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Table of Contents
CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the osteoporosis market
- Osteoporosis is severely underdiagnosed and undertreated. Datamonitor primary research suggests that just 10% of the prevalent population across
the seven major markets is diagnosed with osteoporotic bone loss and only just over half of those receive drug treatment. Growth in this market
depends on driving patient identification and diagnosis, yet this is an area fraught with unmet needs including disease awareness and access to
and utilization diagnostic tools.
- Datamonitor primary research has identified strong variances in class and brand prescribing preferences among physicians, according to both
disease severity and geography. Combination therapy is prescribed in the US, Japan, the UK, France and Spain, though not in Italy and Germany. The
practice varies significantly in the extent of physician participation and use in the patient population
- Three trends in osteoporosis R&D have the potential to radically change treatment and expand the market: SERMs in additional indications;
PTH/anabolic drugs in fracture patients and novel bisphosphonates in flexible dosing and delivery formulations. However, Datamonitor primary
research suggests that prescribers will vary widely in how receptive they are to these innovations.
- Key metrics
CHAPTER 2 INTRODUCTION AND SCOPE
- Coverage of the Stakeholder Insight survey
- Supporting data sets
CHAPTER 3 COUNTRY TREATMENT TREES
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION
- Osteoporosis definition and classification
- Introduction
- Classification of osteoporosis
- Etiology of osteoporosis
- Epidemiology of osteoporosis
- Methodological difficulties in assessing prevalence
- Prevalence of osteoporosis and osteopenia in postmenopausal women
- Prevalence of osteoporosis and osteopenia in men
- Comparative physician-based patient population data
- Osteoporosis population forecast
- Fractures, their implications and minor risk groups
CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS
- Presentation and diagnosis
- The problem of patient identification in osteoporosis
- Diagnosis – techniques and patient population
- Treatment rates
- Treatment options
- Treatment guidelines
CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS
- Prescribing trends
- Drug therapy – an overview
- Geographical trends in osteoporosis drug prescriptions
- HRT in osteoporosis – not fade away?
- Changes in therapy
- Case study: SERMs vs. HRT in osteoporosis
CHAPTER 7 IMPROVING TREATMENT OUTCOMES
- Treatment outcomes
- New product development
- Bisphosphonates in development
- Parathyroid hormone – teriparatide (Forteo)
- Unmet needs
- Physician/patient education
- Diagnostic unmet needs
- Therapeutic unmet needs
CHAPTER 8 OTHER STAKEHOLDER INFLUENCES
- Regulatory perspectives
- Clinical trial endpoints in osteoporosis
- Fracture risk reduction
- Bone turnover markers
- Bone microarchitecture and bone quality
- Clinical trial design in osteoporosis
- Payer/provider perspectives
- Cost-effectiveness in preventive therapy
CHAPTER 9 OPINION LEADER AND STAKEHOLDER TRANSCRIPTS
- Key Opinion Leader 1 – Belgium
- Key Opinion Leader 2 - UK
- Key opinion Leader 3 – UK
- Key Opinion Leader 4 - Germany
APPENDIX A BIBLIOGRAPHY
- Epidemiology
- Clinical trial data
APPENDIX B
- Physician research methodology
- Physician Sample breakdown
- US
- Japan
- France
- Germany
- Italy
- Spain
- UK
- Contributing experts
- Stakeholder Insight: Osteoporosis QUESTIONNAIRE
- 1. Epidemiology
- 2. Screening and Diagnosis
List of Tables
- Table 1: Prevalence of osteoporosis and osteopenia in the seven major markets, 000s, 2003-2011
- Table 2: WHO classification of osteoporotic bone loss
- Table 3: Causes of secondary (Type III) osteoporosis
- Table 4: Prevalence of osteopenia and osteoporosis in postmenopausal women across the seven major markets, 2003
- Table 5: Prevalence of osteopenia and osteoporosis in men over 50 in the seven major markets, 2003
- Table 6: Percentage of interviewed physician' s patients with low bone mass by sex
- Table 7: Estimated forecast of the osteoporosis and osteopenia populations over 50 years in the seven major markets, 000s, 2003(11
- Table 8: Prevalence of vertebral fractures in men and women over 50 in the seven major markets, 2003
- Table 9: Breakdown of osteoporotic populations by disease severity, country and sex, %, 2003
- Table 10: Patients receiving drug treatment by disease severity and country, %, 2003
- Table 11: Patients receiving drug treatment by physicians specialty and disease severity across the seven major markets, %, 2003
- Table 12: Patients receiving either calcium and/or vitamin D by disease severity and by country, %, 2003
- Table 13: Patients receiving either calcium and/or vitamin D by specialty across the seven major markets, %, 2003
- Table 14: Patients receiving different drug classes in monotherapy and by disease severity and by country, %, 2003
- Table 15: Patients receiving bisphosphonates in monotherapy by disease severity and by country, %, 2003
- Table 16: Physician' s responses to the question ' Will positive trial results for SERMs in breast cancer and CVD lead to an increase in the use
of SERMs for osteoporosis?' by country, %, 2003
- Table 17: Physician' s responses to the question ' Will positive trial results for SERMs in breast cancer and CVD lead to an increase in the use
of SERMs for osteoporosis?' by physician specialty, %, 2003
- Table 18: Patient non-compliance at 6, 12 and 12+ month periods by country and disease severity, %, 2003
- Table 19: Importance of treatment outcomes to physicians in response to the question gWhat are the main treatment outcomes for these (osteoporotic)
patients?h across the seven major markets, %, 2003
- Table 20: Physician' s awareness of novel bisphosphonates in development by country, %, 2003
- Table 21: Physicians awareness of novel bisphosphonates in development by specialty, %, 2003
- Table 22: Physicians who that think longer interval dosing will improve compliance by country, %, 2003
- Table 23: Physicians who think that longer interval dosing will improve compliance by specialty, %, 2003
- Table 24: Physicians awareness of Forteo by country, %, 2003
- Table 25: US physician sample breakdown, 2003
- Table 26: Japan physician sample breakdown, 2003
- Table 27: France physician sample breakdown, 2003
- Table 28: Germany physician sample breakdown, 2003
- Table 29: Italy physician sample breakdown, 2003
- Table 30: Spain physician sample breakdown, 2002
- Table 31: UK physician sample breakdown, 2003
List of Figures
- Figure 1: Osteoporosis drug treated population in the seven major markets, according to diagnosis and treatment rates, 2003
- Figure 2: Osteoporosis patient flow schematic, 2003
- Figure 3: Diagrammatic overview of the coverage of the Osteoporosis Stakeholder Insight survey, 2003
- Figure 4: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, US, 2003
- Figure 5: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, Japan, 2003
- Figure 6: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, France, 2003
- Figure 7: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, Germany, 2003
- Figure 8: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, Italy, 2003
- Figure 9: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, Spain, 2003
- Figure 10: Breakdown of monotherapy treatment for the osteoporotic population over 50 years by disease severity, UK, 2003
- Figure 11: Prevalence of osteopenia and osteoporosis in postmenopausal women across the seven major markets, 2003
- Figure 12: Prevalence of osteopenia and osteoporosis in men over 50 in the seven major markets, 2003
- Figure 13: Prevalence of vertebral fractures in men and women over 50 in the seven major markets, 2003
- Figure 14: Estimated rates of patient identification, diagnosis and treatment by country
- Figure 15: Osteoporosis drug treated population in the seven major markets, according to diagnosis and treatment rates, 2003
- Figure 16: Use of diagnostic techniques for osteoporosis by specialty, %, 2003
- Figure 17: Patients receiving drug treatment by physicians specialty and disease severity across the seven major markets, %, 2003
- Figure 18: Percentage of patients receiving drug treatment and calcium and/or vitamin D by severity across the seven major markets, %, 2003
- Figure 19: Physician' s use osteoporosis treatment guidelines by country, %, 2003
- Figure 20: Physician' s use of osteoporosis treatment guidelines by specialty across the seve major market, %, 2003
- Figure 21: Physicians responses to the question ' Are SERMs a viable alternative to HRT in osteoporosis?' , by country, %, 2003
- Figure 22: Physicians responses to the question ' Are SERMs a viable alternative to HRT in osteoporosis?' , by physician specialty, %, 2003
- Figure 23: Physician' s responses to the question ' have you switched any of your patients using HRT for osteopenia or osteoporosis onto a SERM
(Evista)?' by country, %, 2003
- Figure 24: Physician' s responses to the question ' have you switched any of your patients using HRT for osteopenia or osteoporosis onto a SERM
(Evista)?' by physician specialty, %, 2003
- Figure 25: Physician' s responses to the question ' Will positive trial results for SERMs in breast cancer and CVD lead to an increase in the
use of SERMs for osteoporosis?' across the seven major markets, %, 2003
- Figure 26: Physicians prescribing drug/drug combinations by country and disease severity, %, 2003
- Figure 27: Patients receiving any drug/drug combination by country and disease severity, %, 2003
- Figure 28: Strategies to address poor compliance with osteoporosis treatment
- Figure 29: Mean rankings of factors influencing drug choice across the seven major pharmaceutical markets, 2003
- Figure 30: Mean ranking of factors affecting physician' s decision to switch treatment across the seven major markets, 2003
- Figure 31: Physician awareness of novel bisphosphonates in development by candidate, %, 2003
- Figure 32: Critical success factors for treating physicians to prescribe novel bisphosphonates over currently marketed products, 2003
- Figure 33: Osteoporosis patient flow schematic
- Figure 34: Osteoporosis stakeholders: interactions and relationships
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