Specialized Women's Health

Specialized Women Health

The Center for Specialized Women’s Health comprises an interdisciplinary team that specializes in addressing health issues specific to women, such as menstrual disorders, menopause, menopausal hormone therapy, female sexual dysfunction, medical treatment of urinary and fecal incontinence, alternatives to hysterectomy, hormone therapies, uterine fibroids, osteoporosis and care of breast cancer survivors.

Outcomes reported here relate to care by women’s health staff practicing at Cleveland Clinic’s main campus.

Diagnosis of Patients Following Dual-Energy X-Ray Absorptiometry Scan

2014 - 2018

ᵃOsteoporosis = T-score ≤ -2.5

ᵇOsteopenia = -2.4 ≤ T-score < -1.0

Zoledronic Acid Injections Administered for Low Bone Mineral Densityᵃ

2014 – 2018

The center began using zoledronic acid in 2008 intravenously to treat women with osteopenia and osteoporosis. In the majority of patients, this treatment has helped prevent further deterioration of bone mineral density. Their progress over time is reflected in these graphs.

ᵃSome patients received more than 1 injection.

Comparison of adherence to Zoledronic Acid verses Denosumab

The primary objective of this study is to determine if treatment regimen affects patient adherence rates among patients with osteoporosis receiving yearly Zoledronic acid infusions verses biannual Denosumab injections in a retrospective cohort of patients treated at the Center for Specialized Women’s Health (CSWH). The secondary objective of this study is to compare change in bone mineral density (BMD) over time in this cohort of patients.

The electronic medical record system, Epic, was used to conduct a retrospective chart review. Women ages 50-80 with documented osteoporosis who received their first infusion of Zoledronic acid or Denosumab at the CSWH between January 2010 and July 2016 were included in the study. Adherence rates were monitored from the time of initial infusion until July 2018. Non-adherence is defined as failure to receive treatment within 30 days of scheduled dose unless otherwise instructed by the prescribing physician. For patients with two or more DXA scans performed on the same machine during the study period changes in bone mineral density (BMD) were documented.

Sixty five patients were included in this study, 29 received Zoledronic Acid and 36 received Denosumab. Of patients receiving Denosumab 61.1% were compliant with treatment regimen compared to only 31.0% of patients receiving Zoledronic Acid (P=0.002). After adjusting BMI and age, there is no significant difference between the two treatments on BMD change at the spine (P=0.33) or the femoral neck (P=0.12). More studies are need to identify barriers to medication adherence.

Descriptive summary table for primary aim