An Overview of The Global

Longitudinal Study of
Osteoporosis in Women (GLOW)

Financial support for the GLOW study is provided by Warner-Chilcott Company,

LLC and sanofi-aventis to The Center for Outcomes Research,
University of Massachusetts Medical School.
 GLOW Overview Slide Set

This material is dedicated to the public domain.

Please cite any use of this material as follows:

Copyright 2010 University of Massachusetts Medical School

Financial support for GLOW is provided by

Warner-Chilcott Company, LLC and sanofi-aventis
Under a research contract to
The Center for Outcomes Research,
University of Massachusetts Medical School
 Goal

To improve our understanding

of the risks for and prevention of
osteoporosis-related fractures

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 Specific Aims
 Describe the prevalence of risk factors for
osteoporosis-related fractures
 Assess patterns of diagnosis and treatment
of osteoporosis
 Document factors that influence patient
adherence to treatment
 Assess the real-world effectiveness of
osteoporosis treatment
 Identify geographic differences in these data
 Assess self-perceived fracture risk and impact
of fracture on quality of life
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 Epidemiology of Osteoporosis
 Over 200 million people worldwide suffer from
osteoporosis¹
 Approximately 30% of postmenopausal women
in the U.S. and Europe have osteoporosis, of
which 40% will sustain one or more fragility
fractures in their remaining lifetime²
 With aging of the populations, annual
osteoporotic fractures worldwide are estimated
to triple by the year 2050³
¹Cooper et al. Osteoporos Int. 1992 Nov;2(6):285-9
²Melton et al. J Bone Miner Res 1992;7:1005-10
³Reginster et al. Bone 2006;38:S4-S9
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 Design
 Prospective, longitudinal, multinational,
observational cohort study
 Patients sampled through physician practices
 Representative sample of physician practices
within region
 Representative sample of non-institutionalized
women aged 55 and older
 Data collection by annual mail and phone surveys
 2:1 over-sampling of women ≥65 years of age

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 Physician Practices

 Primary care and general practice physicians

 Were recruited through
– Established primary care physician research
networks (Not networks specific to bone
research)
– Physician practice associations
– From a representative sample of primary care
physicians in each pre-defined study region

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 Scope of Letter Survey
 Demographic data
 Medical history
 Risk factors for osteoporosis-related fracture
 Fracture history
 Self-report of prevention, diagnosis and
treatment of osteoporosis
 Health and functional status
 Health-service access and utilization

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 Study Sample Frame

 Countries 10
 Study sites 17
 Physicians 723
 Women 60,393

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Europe: 8 Regional Centers

Southampton
Cyrus Cooper Amsterdam
& Juliet Compston J. Coen Netelenbos

Leuven Essen
Steven Boonen Johannes Pfeilschifter

Paris
Christian Roux

Verona
Lyon
Silvano Adami
Roland Chapurlat

Barcelona
Adolfo Díez- Pérez

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United States: 7 Regional Centers

Seattle, WA
Andrea LaCroix
Worcester, MA
New York, NY Stephen Gehlbach
Robert Lindsay & Ethel Siris

Cincinnati, OH Pittsburgh, PA
Nelson Watts Susan Greenspan

Los Angeles
Stuart Silverman Birmingham, AL
Ken Saag

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 Australia and Canada

Hamilton, Ontario
Jonathan Adachi

Sydney
Philip Sambrook

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 Survey Domains

 Baseline:
– Risk perception
– Risk factors
– Fracture history
– Functional status
– Quality of life
 Follow-up:
– Incident fractures
– Discontinuation or change in treatment

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 Study Subjects

60,393 Women Enrolled

 Enrollment phase completed April 1, 2008
 From 723 physicians in 17 cities in
10 countries
 61% are 65 years of age or older

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 First Publication:
GLOW Rational and Study Design

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 Enrollment by Geographic Region

Canada/
Europe USA Total
Australia

Sites 8 7 2 17

Physicians 339 298 86 723

Subjects 25,334 28,170 6,889 60,393

Hooven FH et al. Osteoporosis Int 2009;20:1107-16

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 Characteristics of Enrolled Women
GLOW Glow NHANES
Characteristic Overall U.S. Women
(n=60,393) (n=28,170) (2005-06)
Mean age, years 69 69 68
Mean weight, lb 148 159 163
%
Weight<125 lb (57 kg) 16 15 16
Education Level
Less than high school NA 7.4 23
High school NA 26 30
More than high school NA 67 47

Hooven FH et al. Osteoporosis Int 2009;20:1107-16

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Baseline History of Fractures

Hooven FH et al. Osteoporosis Int 2009;20:1107-16 18

Frequency of Comorbid Conditions

Hooven FH et al. Osteoporosis Int 2009;20:1107-16 19

Fair or Poor General Health (Self-report)

Hooven FH et al. Osteoporosis Int 2009;20:1107-16 20

 Awareness of Osteoporosis
Percent
Concern about osteoporosis
Very concerned 25
Somewhat concerned 54
Talked with their doctor about osteoporosis 43
Doctor told subject she had osteoporosis 21
Doctor told subject she had osteopenia 19
Self-rated risk of osteoporosis
Lower 33
Higher 19

Hooven FH et al. Osteoporosis Int 2009;20:1107-16

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 Limitations of Previous Studies
Addressed by GLOW
 Inclusion of subjects previously diagnosed with
osteoporosis
 Ability to compare regional variations using
standard survey instruments
 Inclusion of the full range of available
pharmacological treatments of osteoporosis
 Ability to compare fracture rates among treated
and untreated women
 Ability to assess impact of treatment on fracture
incidence in a “real world” setting
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 Conclusions
 GLOW provides longitudinal and multi-national
estimates of risk factors for osteoporosis-related
fractures in a large sample of women
 Risk factors are common, and show geographic
variation
 Quality of life data permits robust estimation of
costs and benefits for women with different types
of fracture, and different risk exposures
 GLOW findings can inform initiatives to enhance
persistence with drug therapy

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 Publications

 Published manuscripts = 3

 Published abstracts = 39

http://www.outcomesumassmed.org/glow/bibliography.cfm

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 Scientific Advisory Committee
Co-Chairs: Robert Lindsay and Adolfo Díez-Pérez
Australia Netherlands
Philip N. Sambrook J. Coen Netelenbos
Belgium Spain
Steven Boonen Adolfo Díez-Pérez
Canada United Kingdom
Jonathan D. Adachi Juliet E. Compston
Germany Cyrus Cooper
Johannes Pfeilschifter United States
France Stephen H. Gehlbach
Roland D. Chapurlat Susan L. Greenspan
Pierre Delmas (deceased) Andrea Z. LaCroix
Christian Roux Robert Lindsay
Kenneth G. Saag
Italy
Stuart L. Silverman
Silvano Adami
Ethel S. Siris
Nelson B. Watts

Study coordinated by The Center for Outcomes Research,

University of Massachusetts Medical School 25