THIS MANUSCRIPT IS PROVIDED IN CONFIDENCE TO DETERMINE REPRINT INTEREST ONLY AND SHOULD NOT BE DISTRIBUTED EITHER INTERNALLY OR EXTERNALLY VIA PRINT OR ELECTRONIC MEDIA FOR OTHER THAN THE STATED PURPOSE. Physician Differences in Managing Postmenopausal Osteoporosis Results from the POSSIBLE USTreatment Registry Study

Background: Osteoporosis is a disease that often goes undetected until a fracture occurs. Previous reports indicate that disease diagnosis and care of patients with osteoporosis may vary within the medical community. Objective: Using data from the POSSIBLE USregistry (October 2004-December 2009), we evaluated patterns of care for a group of primary care (i.e. first-contact) physicians who frequently prescribe osteoporosis medications to determine whether variations existed in the characteristics of their postmenopausal patients; physician approaches to diagnosis; treatment choices and monitoring; and patient-reported medication use. Methods: POSSIBLE USwas a large prospective registry of postmeno- pausal women receiving osteoporosis treatment. We analysed data from 42 family practice physicians (FPPs), 50 internal medicine specialists (IMs) (internists, physicians), 41 gynaecologists (GYNs) and the 4917 patients they enrolled in the POSSIBLE USregistry between October 2004 and January 2007. Women who had been postmenopausal for at least 1 year and who were newly initiating osteoporosis therapy, switching or augmenting therapy or continuing on a stable therapy regimen were investigated. Therapies included bisphosphonates, full-length or peptide derivative of parathyroid hormone, calcitonin, oral or transdermal postmenopausal estrogen, selective estrogen receptor modulators (SERMs), calcium and/or vitamin D supplements (alone or in combination with other therapies), or any combination of these agents. Data on physician characteristics were collected on an initial qualification questionnaire. Physicians reported data for enrolled patients at study entry and were also asked to provide relevant data obtained at clinic visits throughout the follow-up period. Patient-reported data were collected using