All ETDs from UAB

Advisory Committee Chair

Bisakha Sen

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Osteoporosis is increasingly recognized as a major public health issue in the aging U.S. population. Shortly after the licensure of romosozumab, an injectable medication indi-cated for women with postmenopausal osteoporosis at high risk of fracture administered by health care provider monthly, the COVID-19 pandemic broke out, which caused ma-jor disruptions to the delivery of health care across the nation. The pandemic dispropor-tionately affected minority and economically disadvantaged communities, exacerbating many pre-existing health disparities. Romosozumab has the highest dosing frequency among common injectable osteoporosis medications in the U.S. that require an office visit for injection, making romosozumab adherence more susceptible to changes in healthcare delivery due to public health emergencies such as the COVID-19 pandemic. To date, little is known about the utilization and its disparities for romosozumab, partic-ularly in light of the shifts to remote care where in-person visits were infeasible due to changes wrought by the pandemic. Thus, this dissertation aimed to evaluate the associa-tion between the COVID-19 pandemic, social determinants of health, and romosozumab utilization among Medicare enrollees in the U.S. The main findings of this dissertations were as follows. First, we developed and validated a deterministic claims-based algorithm to accurately identify romosozumab administration from Medicare claims data. We also tested the feasibility of data mining approaches. Second, we demonstrated that the COVID lockdown had negative effects on romosozumab administrations among its users residing in the most socioeconomically vulnerable counties. Third, we illustrated the association between area social vulnerabil-ity and the discontinuation of romosozumab treatment. Specifically, Medicare enrollees residing in areas with greater social vulnerabilities were more likely to discontinue ro-mosozumab. These findings highlighted the necessity of maintaining essential healthcare for individuals with chronic diseases such as osteoporosis during public health emergencies like COVID-19, particularly for those residing in socioeconomically vulnerable communities.

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