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Almohaileb FI, Rasheed Z. Comparing the efficacies of bisphosphonates' therapies for osteoporosis persistence and compliance: A Systematic Review. Curr Mol Med 2021; 22:274-284. [PMID: 33855941 DOI: 10.2174/1566524021666210414100227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Osteoporosis is the most prevalent metabolic bone disorder worldwide. This review was undertaken to compare the efficacies of bisphosphonates therapies for patient persistence and compliance for the treatment of osteoporosis. METHODS A systematic review was performed in accordance with the available reporting items. MEDLINE and Cochrane library databases were applied for literature searched up to January 2020. All major studies such as prospective, retrospective and reviews articles that examined patient persistence or compliance to bisphosphonates for osteoporosis were included. RESULTS Literature search found 656 relevant published reports, out of which 87 were included. The 10,712,176 osteoporotic patients were studied for patient persistence and 5,875,718 patients were studied for patient compliances. Analysis of all studied bisphosphonates showed almost similar patterns for patient persistence rates as it was decreased over the time following initial prescription but persistence length was found to be significantly high for alendronate therapy as compared to the other studied bisphosphonates (p<0.001), whereas the length of persistence of all other bisphosphonates (other than alendronate) were almost same (p>0.05). Analysis of patient compliances with etidronate therapy showed the highest percent medication possession ratio (MRP) at 12 months, followed by the MRPs of ibandronate, alendronate, risedronate, and clodronate. CONCLUSIONS This is the first systematic review that shows the comparison of the efficiencies of bisphosphonates for patient persistence and compliance for the treatment of osteoporosis. The data showed that the length of patient persistence was highest for alendronate therapy, whereas patient compliance was highest for etidronate therapy for the treatment of osteoporosis.
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Affiliation(s)
- Faisal I Almohaileb
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Persistence with oral bisphosphonates and denosumab among older adults in primary care in Ireland. Arch Osteoporos 2021; 16:71. [PMID: 33864529 PMCID: PMC8053179 DOI: 10.1007/s11657-021-00932-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Gaps in pharmacological treatment for osteoporosis can reduce effectiveness. Among older adults, we found about half of new users of oral bisphosphonate and denosumab persisted with their treatment at 2 years, with few switching to alternative therapy. Persistence is suboptimal and warrants evaluation of interventions to improve this. PURPOSE Gaps in pharmacological treatment for osteoporosis can reduce effectiveness. This study aimed to estimate persistence rates for oral bisphosphonates and denosumab in older primary care patients and identify factors associated with discontinuation. METHODS Older patients newly prescribed oral bisphosphonates or denosumab during 2012-2017 were identified from 44 general practices (GP) in Ireland. Persistence without a coverage gap of >90 days was calculated for both medications from therapy initiation. Factors associated with time to discontinuation were explored using Cox regression analysis. Exposures included age group, osteoporosis diagnosis, fracture history, calcium/vitamin D prescription, number of other medications, health cover, dosing frequency (bisphosphonates) and previous bone-health medication (denosumab). RESULTS Of 41,901 patients, n=1569 were newly initiated on oral bisphosphonates and n=1615 on denosumab. Two-year persistence was 49.4% for oral bisphosphonates and 53.8% for denosumab and <10% were switched to other medication. Having state-funded health cover was associated with a lower hazard of discontinuation for both oral bisphosphonates (HR=0.49, 95% CI=0.36-0.66, p<0.01) and denosumab (HR=0.71, 95% CI=0.57-0.89, p<0.01). Older age group, number of medications and calcium/vitamin D prescription were also associated with better bisphosphonate persistence, while having osteoporosis diagnosed was associated with better denosumab persistence. CONCLUSION Persistence for osteoporosis medications is suboptimal. Of concern, few patients are switched to other bone-health treatments when denosumab is stopped which could increase fracture risk. Free access to GP services and medications may have resulted in better medication persistence in this cohort. Future research should explore prescribing choices in primary care osteoporosis management and evaluate cost-effectiveness of interventions for improving persistence.
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Choi HS. Why Do We Need Proactive Management for Fracture Prevention in Long-Term Glucocorticoid Users? Endocrinol Metab (Seoul) 2020; 35:549-551. [PMID: 32981297 PMCID: PMC7520581 DOI: 10.3803/enm.2020.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Abstract
Osteoporosis is an increasing public health problem that impacts quality of life. Fractures are a common consequence of poor bone health, resulting in enormous health care, personal, and socioeconomic burden. Bone health can be managed, and osteoporosis can be prevented and diagnosed before a fracture or subsequent fracture. Nurses should consider bone health assessment and counseling as part of their standard for all patients. The evidence-based information presented regarding prevention, screening, diagnosis, and treatment is intended to fight the osteoporosis epidemic, resulting in a reduction of the treatment gap and reduced fracture risk among those to whom nurses provide care.
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Affiliation(s)
- Debra L Sietsema
- Bone Health Clinical Operations, The CORE Institute®, Phoenix, AZ, USA; Grants and Education, MORE Foundation, Phoenix, AZ, USA.
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Fatoye F, Smith P, Gebrye T, Yeowell G. Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review. BMJ Open 2019; 9:e027049. [PMID: 30987990 PMCID: PMC6500256 DOI: 10.1136/bmjopen-2018-027049] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study examined patient adherence and persistence to oral bisphosphonates for the treatment of osteoporosis in real-world settings. METHODS A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database NHS EED) databases were searched for studies published in English language up to April 2018. Prospective and retrospective observational studies that used prescription claim databases or hospital medical records to examine patient adherence and persistence to oral bisphosphonate treatment among adults with osteoporosis were included. The Newcastle-Ottawa quality assessment scale (NOS) was used to assess the quality of included studies. RESULTS The search yielded 540 published studies, of which 89 were deemed relevant and were included in this review. The mean age of patients included within the studies ranged between 53 to 80.8 years, and the follow-up varied from 3 months to 14 years. The mean persistence of oral bisphosphonates for 6 months, 1 year and 2 years ranged from 34.8% to 71.3%, 17.7% to 74.8% and 12.9% to 72.0%, respectively. The mean medication possession ratio ranged from 28.2% to 84.5%, 23% to 50%, 27.2% to 46% over 1 year, 2 years and 3 years, respectively. All studies included scored between 6 to 8 out of 9 on the NOS. The determinants of adherence and persistence to oral bisphosphonates included geographic residence, marital status, tobacco use, educational status, income, hospitalisation, medication type and dosing frequency. CONCLUSIONS While a number of studies reported high levels of persistence and adherence, the findings of this review suggest that patient persistence and adherence with oral bisphosphonates medications was poor and reduced notably over time. Overall, adherence was suboptimal. To maximise adherence and persistence to oral bisphosphonates, it is important to consider possible determinants, including characteristics of the patients.
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Affiliation(s)
- F Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - P Smith
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - T Gebrye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - G Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Yeam CT, Chia S, Tan HCC, Kwan YH, Fong W, Seng JJB. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int 2018; 29:2623-2637. [PMID: 30417253 DOI: 10.1007/s00198-018-4759-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023]
Abstract
The aim of this review was to identify factors that influence patients' adherence to anti-osteoporotic therapy. Factors identified that were associated with poorer medication adherence included polypharmacy, older age, and misconceptions about osteoporosis. Physicians need to be aware of these factors so as to optimize therapeutic outcomes for patients. INTRODUCTION To identify factors that influence patients' adherence to anti-osteoporotic therapy. METHODS A systematic review of literature was performed for articles published up till January 2018 using PubMed®, PsychINFO®, Embase®, and CINAHL®. Peer-reviewed articles which examined factors associated with anti-osteoporotic medication adherence were included. Classes of anti-osteoporotic therapy included bisphosphonates, parathyroid hormone-related analogue, denosumab, selective estrogen receptor modulators, estrogen/progestin therapy, calcitonin, and strontium ranelate. Meta-analyses, case reports/series, and other systematic reviews were excluded. Identified factors were classified using the World Health Organization's five dimensions of medication adherence (condition, patient, therapy, health-system, and socio-economic domains). RESULTS Of 2404 articles reviewed, 124 relevant articles were identified. The prevalence of medication adherence ranged from 12.9 to 95.4%. Twenty-four factors with 139 sub-factors were identified. Bisphosphonates were the most well-studied class of medication (n = 59, 48%). Condition-related factors that were associated with poorer medication adherence included polypharmacy, and history of falls was associated with higher medication adherence. Patient-related factors which were associated with poorer medication adherence included older age and misconceptions about osteoporosis while therapy-related factors included higher dosing frequency and medication side effects. Health system-based factors associated with poorer medication adherence included care under different medical specialties and lack of patient education. Socio-economic-related factors associated with poorer medication adherence included current smoker and lack of medical insurance coverage. CONCLUSION This review identified factors associated with poor medication adherence among osteoporotic patients. To optimize therapeutic outcomes for patients, clinicians need to be aware of the complexity of factors affecting medication adherence.
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Affiliation(s)
- C T Yeam
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - S Chia
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - H C C Tan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Y H Kwan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - W Fong
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J J B Seng
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Abstract
Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis and the resulting fractures cause significant morbidity. Following initiation of oral glucocorticoids, rapid bone loss occurs, and fracture risk increases within a few months in a dose-dependent manner. These adverse effects are due to inhibition of bone formation accompanied by an early but transient increase in bone resorption. Multiple mechanisms underlie these changes in bone remodeling; direct effects include upregulation of PPARγR2, increased expression of sclerostin and increased RANKL/OPG ratio, whilst hypogonadism, altered renal and intestinal calcium handling, and reduced production of insulin-like growth factor 1 also contribute. Fracture risk assessment should be performed as soon as possible after glucocorticoids are initiated and bone protective therapy started promptly in individuals at high-risk, with calcium and vitamin D supplements where appropriate. Oral bisphosphonates are currently regarded as first line options on the grounds of their low cost. However, teriparatide has been shown to be superior in its effects on BMD and vertebral fracture risk in glucocorticoid-treated individuals with osteoporosis and should be considered as an alternative first line option in high-risk patients.
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Affiliation(s)
- Juliet Compston
- Department of Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0SL, UK.
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Karlsson L, Lundkvist J, Psachoulia E, Intorcia M, Ström O. Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis. Osteoporos Int 2015; 26:2401-11. [PMID: 26282229 PMCID: PMC4575381 DOI: 10.1007/s00198-015-3253-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
UNLABELLED The objectives of this study were to estimate persistence with denosumab and put these results in context by conducting a review of persistence with oral bisphosphonates. Persistence with denosumab was found to be higher than with oral bisphosphonates. PURPOSE This study had two objectives: to analyse persistence in Swedish women initiating denosumab for treatment of postmenopausal osteoporosis (PMO) and to put these findings in context by conducting a literature review and meta-analysis of persistence data for oral bisphosphonates. METHODS The study used the Swedish Prescribed Drug Register and included women aged at least 50 years initiating denosumab between May 2010 and July 2012. One injection of denosumab was defined as 6-month persistence. Women were considered persistent for another 6 months if they filled their next prescription within 6 months + 56 days and survival analysis applied to the data. A literature search was conducted in PubMed to identify retrospective studies of persistence with oral bisphosphonates and pooled persistence estimates were calculated using a random-effects model. RESULTS The study identified 2,315 women who were incident denosumab users. Mean age was 74 years and 61% had been previously treated for PMO. At 12 and 24 months, persistence with denosumab was 83% (95% CI, 81-84%) and 62% (95% CI, 60-65%), respectively. The literature search identified 40 articles for inclusion in the meta-analysis. At 12 and 24 months, persistence with oral bisphosphonates ranged from 10% to 78% and from 16% to 46%, with pooled estimates of 45% and 30%, respectively. CONCLUSION These data from the Swedish Prescribed Drug Register and literature review suggest that persistence was higher with denosumab than with oral bisphosphonates.
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Affiliation(s)
- L Karlsson
- Quantify Research, Hantverkargatan 8, SE-112 21, Stockholm, Sweden.
| | - J Lundkvist
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | | | | | - O Ström
- Quantify Research, Hantverkargatan 8, SE-112 21, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centrum (MMC), Karolinska Institutet, Stockholm, Sweden
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Saag KG, Curtis J, Warriner A. Challenges in defining quality of care for glucocorticoid-induced osteoporosis: defending good against perfect. J Rheumatol 2014; 40:1640-2. [PMID: 24085752 DOI: 10.3899/jrheum.130980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Cevikoi A, Umay E, Polat S, Ecerkale O, Cakci A. The relationship between bisphosphonate use and demographic characteristics of male osteoporosis patients. Clinics (Sao Paulo) 2011; 66:579-82. [PMID: 21655750 PMCID: PMC3093787 DOI: 10.1590/s1807-59322011000400010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 01/04/2011] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study aimed to investigate a number of demographic characteristics in males with osteoporosis (OP) treated with bisphosphonate and determine whether any of these measures could act as an effective indicator of medication persistence and compliance. MATERIAL AND METHOD Among the patients with OP who applied to our clinic and were prescribed weekly oral bisphosphonate treatment, 89 patients over 50 years of age were included in this study. The demographic characteristics of these patients were evaluated. The number of medications used by the patients over the past 1 and 3 years were counted, and the persistence and compliance with bisphosphonate treatment was estimated. The patients were divided into two groups: fully compliant and noncompliant subjects. The two groups of patients were compared separately for 1 and 3 years while considering their demographic characteristics. RESULTS The mean age of the 89 patients included in the study was 62.43 ± 9.41 years. Comparisons among the studied demographic characteristics during the 1-year period of medication use indicated that the educational status of the fully compliant patients was higher. During the 3-year period of medication use, educational status was the only demographic characteristic that was determined to be significantly lower in the noncompliant patients than in the fully compliant group. CONCLUSION Although deficiencies in medication persistence and compliance during osteoporosis treatment can lead to serious health and social problems in both genders, the causes of these deficiencies have not been thoroughly clarified. We suggest that the educational status of the patient may contribute to these deficiencies.
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Affiliation(s)
- Alev Cevikoi
- Ministry of Health Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
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Caplan L, Hines AE, Williams E, Prochazka AV, Saag KG, Cunningham F, Hutt E. An observational study of glucocorticoid-induced osteoporosis prophylaxis in a national cohort of male veterans with rheumatoid arthritis. Osteoporos Int 2011; 22:305-15. [PMID: 20358362 DOI: 10.1007/s00198-010-1201-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED We applied regression techniques to a large cohort of patients to understand why certain patients are prescribed medications to prevent glucocorticoid-induced osteoporosis (GIO). Rates of prescriptions to prevent osteoporosis were low. The presence of drugs and disorders associated with osteoporosis and gastrointestinal conditions actually are associated with a decreased likelihood of receiving osteoporosis-preventing medications. INTRODUCTION To understand why some patients are prescribed medications to prevent GIO while other patients are not, we examined whether there is an association among osteoporosis-inducing medical conditions or medications and prescriptions for osteoporosis prophylaxis in a large cohort of rheumatoid arthritis patients on chronic glucocorticoids. METHODS Department of Veterans' Affairs national administrative databases were used to construct a cohort (n = 9,605) and provide the data for this study. Multivariate logistic regression was performed to determine medical conditions and medications associated with dispensing of GIO-preventive medications, controlling for sociodemographic variables, comorbidities, glucocorticoid dosage, prior fractures, and rheumatoid arthritis severity. A subanalysis examined predictors of early GIO prevention. RESULTS Subjects were more likely to receive GIO prophylaxis if they were older, African American, treated with multiple antirheumatic disease-modifying drugs, or received greater glucocorticoid exposure. The prescription of certain drug classes (loop diuretics and anticonvulsants) and conditions (malignancy, renal insufficiency, alcohol abuse, and hepatic disease) were associated with lower likelihood of GIO prophylaxis, despite putative links between these agents/conditions and osteoporosis. The presence of gastrointestinal disorders dramatically decreased likelihood of GIO prophylaxis. Few characteristics predicted the dispensing of GIO-preventing medications within 7 days of the initial glucocorticoid start date. CONCLUSIONS Rates of prescriptions to prevent osteoporosis in a cohort of older men with rheumatoid arthritis on chronic glucocorticoids were low. Gastrointestinal disorders and drugs and disorders potentially linked to osteoporosis are associated with diminished odds of being prescribed GIO-preventing medications.
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Affiliation(s)
- L Caplan
- Denver VA Medical Center, 1055 Clermont St, Research 151, Denver, CO 80220, USA.
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Cadarette SM, Katz JN, Brookhart MA, Stürmer T, Stedman MR, Levin R, Solomon DH. Comparative gastrointestinal safety of weekly oral bisphosphonates. Osteoporos Int 2009; 20:1735-47. [PMID: 19266138 PMCID: PMC3257315 DOI: 10.1007/s00198-009-0871-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 01/09/2009] [Indexed: 01/11/2023]
Abstract
SUMMARY Weekly bisphosphonates are the primary agents used to treat osteoporosis. Although these agents are generally well tolerated, serious gastrointestinal adverse events, including hospitalization for gastrointestinal bleed, may arise. We compared the gastrointestinal safety between weekly alendronate and weekly risedronate and found no important difference between new users of these agents. INTRODUCTION Weekly bisphosphonates are the primary agents prescribed for osteoporosis. We examined the comparative gastrointestinal safety between weekly bisphosphonates. METHODS We studied new users of weekly alendronate and weekly risedronate from June 2002 to August 2005 among enrollees in a state-wide pharmaceutical benefit program for seniors. Our primary outcome was hospitalization for upper gastrointestinal bleed. Secondary outcomes included outpatient diagnoses for upper gastrointestinal disease, symptoms, endoscopic procedures, use of gastroprotective agents, and switching between therapies. We used Cox proportional hazard models to compare outcomes between agents within 120 days of treatment initiation, adjusting for propensity score quintiles. We also examined composite safety outcomes and stratified results by age and prior gastrointestinal history. RESULTS A total of 10,420 new users were studied, mean age = 79 years (SD, 6.9), and 95% women. We observed 31 hospitalizations for upper gastrointestinal bleed (0.91 per 100 person-years) within 120 days of treatment initiation. Adjusting for covariates, there was no difference in hospitalization for upper gastrointestinal bleed among those treated with risedronate compared with alendronate (HR, 1.12; 95%CI, 0.55 to 2.28). Risedronate switching rates were lower; otherwise, no differences were observed for secondary or composite outcomes. CONCLUSIONS We found no important difference in gastrointestinal safety between weekly oral bisphosphonates.
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Affiliation(s)
- S M Cadarette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Improving the prediction of medication compliance: the example of bisphosphonates for osteoporosis. Med Care 2009; 47:334-41. [PMID: 19194337 DOI: 10.1097/mlr.0b013e31818afa1c] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Administrative claims data have a limited ability to identify persons with high compliance to oral bisphosphonates. We tested whether adding information on compliance with other drugs used to treat chronic, asymptomatic conditions would improve the predictive ability of administrative data to identify adherent individuals. METHODS Using data from a large, US healthcare organization, we identified new bisphosphonate users and their 1-year compliance to oral bisphosphonates, quantified by the Medication Possession Ratio (MPR). Multivariable logistic regression models evaluated the relationship between high bisphosphonate compliance (MPR >or=80%) and patient demographics, comorbidities, and health services utilization. To these logistic regression models, we evaluated the incremental change in the area under the receiver operator curve (AUC) after adding information regarding compliance with other drug classes. These included antihyperlipidemics (statins), antihypertensives, antidepressants, oral diabetes agents, and glaucoma medications. Results from the logistic regression models were evaluated in parallel using recursive partitioning trees with 10-fold cross-validation. RESULTS Among 101,038 new bisphosphonate users, administrative data identified numerous nonmedication factors (eg, age, gender, use of preventive services) significantly associated with high bisphosphonate compliance at 1 year. However, all these factors in aggregate had low discriminant ability to identify persons highly adherent with bisphosphonates (AUC = 0.62). For persons who were new users of >or=1 of the other asymptomatic condition drugs, MPR data on the other drugs substantially improved the prediction of high bisphosphonate compliance. The impact on prediction was largest for concomitant statin users (AUC = 0.70). CONCLUSIONS Information on compliance with drugs used to treat chronic asymptomatic conditions improves the prediction of compliance with oral bisphosphonates. This information may help identify persons who should receive targeted interventions to promote compliance to osteoporosis medications.
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Barrett-Connor E, Ensrud K, Tosteson ANA, Varon SF, Anthony M, Daizadeh N, Wade S. Design of the POSSIBLE UStrade mark Study: postmenopausal women's compliance and persistence with osteoporosis medications. Osteoporos Int 2009; 20:463-72. [PMID: 18607669 DOI: 10.1007/s00198-008-0674-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 05/29/2008] [Indexed: 11/30/2022]
Abstract
UNLABELLED Failure to take prescribed medication is common. The POSSIBLE US study is evaluating the impact of physician and patient characteristics on patient-reported compliance and persistence with osteoporosis medications. We report our study design and the baseline characteristics of 4,994 postmenopausal women recruited from primary care physician offices in 33 states. INTRODUCTION The Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US) is a longitudinal cohort study of osteoporosis therapy in primary care. METHODS Between 2004 and 2007, 134 physicians (in 33 states) enrolled postmenopausal women initiating, changing, or continuing osteoporosis medications. After completing a baseline questionnaire, participants will provide data semi-annually for up to 3 years through 2008. Physicians provide patient data at baseline and routine follow-up visits. Participants from 23 sites also signed a release regarding administrative claims data for economic analyses and validation of self-reported data. BASELINE RESULTS Four thousand nine hundred and ninety-four evaluable women were recruited from internal medicine (n = 1,784), family practice (n = 1,556), obstetrics/gynecology (n = 1,556), and from one rheumatology practice (n = 98). Mean participant age was 64.3 years (SD = 9.97); 89% were Caucasian; 59% had some college education. Sixty-three percent used a single osteoporosis agent, usually a bisphosphonate. For monotherapy patients, concordance between clinic- and patient-reported medication use was lowest for patients prescribed estrogen therapy (70%) or calcium/vitamin D (72%). Obstetrician/gynecologists enrolled younger women, who were more likely to use estrogen therapy than patients enrolled by other physicians. The 934 women (19%) prescribed only calcium/vitamin D were younger than women prescribed pharmacologic therapy. CONCLUSIONS POSSIBLE US provides a unique foundation for evaluating longitudinal use of osteoporosis medications and related outcomes.
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Affiliation(s)
- E Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0607, USA.
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Ideguchi H, Ohno S, Takase K, Ueda A, Ishigatsubo Y. Outcomes after switching from one bisphosphonate to another in 146 patients at a single university hospital. Osteoporos Int 2008; 19:1777-83. [PMID: 18458987 DOI: 10.1007/s00198-008-0618-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Accepted: 03/10/2008] [Indexed: 11/25/2022]
Abstract
UNLABELLED Most patients who switched to a second bisphosphonate continued their treatment long term, although those who stopped their first drug because of adverse events were likely to discontinue the second drug for the same reason. Switching to another bisphosphonate is a reasonable treatment option for some patients with treatment failure. INTRODUCTION Patients who experience treatment failure with a bisphosphonate because of adverse events (AEs) or other reasons might receive a second bisphosphonate. However, the frequency and benefits of switching bisphosphonates are unknown. METHODS We retrospectively evaluated 197 men and 1110 women newly treated with bisphosphonates between 1 January 2000 and 30 June 2005 at our university hospital. RESULTS Among the 497 patients who discontinued bisphosphonate treatment, 146 were switched to a second bisphosphonate. The cumulative probabilities of persistence of treatment after 3 years were 45% with the first bisphosphonate and 65% with the second (P = 0.017). Age >or=65 years, switching bisphosphonates because of AEs, and male gender were associated (P < 0.05) with low persistence of treatment with the second bisphosphonate. Discontinuation of the first drug because of AEs was associated with an increased rate of discontinuation of the second drug because of AEs (hazard ratio, 4.2; 95% confidence interval, 2.1-8.4). CONCLUSIONS Patients who switched bisphosphonates had high rates of persistence of therapy. Those who stopped their first bisphosphonate because of AEs were at risk of discontinuing the second drug for the same reason. Switching to another bisphosphonate is a reasonable treatment option for some patients with treatment failure.
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Affiliation(s)
- H Ideguchi
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
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Curtis JR, Westfall AO, Cheng H, Delzell E, Saag KG. Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int 2008; 19:1613-20. [PMID: 18483689 PMCID: PMC2574626 DOI: 10.1007/s00198-008-0604-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 02/14/2008] [Indexed: 11/29/2022]
Abstract
UNLABELLED Based upon interest in a bisphosphonate drug holiday, we evaluate the risk for hip fracture after bisphosphonate discontinuation. Among women compliant with bisphosphonates for > or = 2 years, the risk of hip fracture was increased after discontinuation, although with higher compliance and a longer duration of preceding bisphosphonate therapy, this risk was attenuated. INTRODUCTION Recent data suggest that hip fracture risk was not significantly increased among women receiving 5 years of bisphosphonate therapy who were subsequently randomized to placebo. We studied older women compliant with bisphosphonates > or = 2 years to evaluate the risk of hip fracture after bisphosphonate discontinuation. METHODS Using administrative databases from a large U.S. healthcare organization, we identified women initiating bisphosphonate therapy compliant (Medication Possession Ratio, MPR > or = 66%) for 2 years. We examined the rate of hip fracture among women who discontinued bisphosphonates versus those who remained on therapy. RESULTS At 2 years, 9,063 women were eligible for analysis. Hip fracture incidence among women who discontinued bisphosphonates versus those who did not was 8.43 versus 4.67 per 1000 person years (p = 0.016). The adjusted hazard ratio of hip fracture per 90 days following discontinuation was 1.2 (1.1-1.3). For women with higher compliance at 2 years (MPR > or = 80%) or compliant for 3 years, there were no significant differences in risk associated with discontinuation. CONCLUSIONS The rate of hip fracture was increased among women compliant with bisphosphonate therapy for 2 years who subsequently discontinued, suggesting that discontinuation is not advisable under these conditions. This association was attenuated with higher compliance and a longer duration of previous bisphosphonate therapy.
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Affiliation(s)
- J R Curtis
- Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL, USA.
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18
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Vytrisalova M, Blazkova S, Palicka V, Vlcek J, Cejkova M, Hala T, Pavelka K, Koblihova H. Self-reported compliance with osteoporosis medication-qualitative aspects and correlates. Maturitas 2008; 60:223-9. [PMID: 18774663 DOI: 10.1016/j.maturitas.2008.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 06/30/2008] [Accepted: 07/02/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The analysis aims to assess (1) compliance with anti-osteoporosis pharmacotherapy and (2) the prevalence of calcium and vitamin D co-medication among Czech women in common clinical practice. METHODS A cross-sectional multicentre questionnaire survey was performed in consecutive secondary care female patients aged > or =40 years. Three main dimensions of compliance were studied: drug compliance (based on missed doses over the last month), co-medication with calcium/vitamin D and compliance with dosing instructions for safe and effective use of bisphosphonates (BIS). RESULTS The therapy in 200 osteoporosis patients was alendronate (44.5%), risedronate (24.5%), raloxifene (18%) and calcitonin (13%). The three dimensions of compliance were not associated with each other. None of the compliance-related outcomes correlated with the osteoporosis knowledge score obtained in the Osteoporosis Questionnaire (OPQ) of Pande et al. The most frequently reported reason for non-compliance was "drug not handy". Similar mean compliance rates were achieved with once daily and once weekly BIS. The rates of current calcium and vitamin D co-medication were 73% and 62%, respectively. Calcium co-medication was associated with obtaining information on medications against osteoporosis from other sources besides health care professionals (P = 0.038). Compliance with dosing instructions correlated negatively with age (P = 0.001). CONCLUSION Compliance with osteoporosis medication in Czech women is suboptimal, in particular the prevalence of co-medication with calcium/vitamin D should be higher. It is needed to implement strategies focused on the patient's beliefs about the disease and perceptions of outcome rather than those promoting the knowledge alone.
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Affiliation(s)
- Magda Vytrisalova
- Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove, Czech Republic. magda.vytrisalovafaf.cuni.cz
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19
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Benefit of adherence with bisphosphonates depends on age and fracture type: results from an analysis of 101,038 new bisphosphonate users. J Bone Miner Res 2008; 23:1435-41. [PMID: 18442318 PMCID: PMC2574615 DOI: 10.1359/jbmr.080418] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The relationship between high adherence to oral bisphosphonates and the risk of different types of fractures has not been well studied among adults of different ages. Using claims data from a large U.S. health care organization, we quantified adherence after initiating bisphosphonate therapy using the medication possession ratio (MPR) and identified fractures. Cox proportional hazards models were used to evaluate the rate of fracture among nonadherent persons (MPR < 50%) compared with highly adherent persons (MPR >or= 80%) across several age strata and a variety of types of clinical fractures. In conjunction with fracture incidence rates among the nonadherent, these estimates were used to compute the number needed to treat with high adherence to prevent one fracture, by age and fracture type. Among 101,038 new bisphosphonate users, the proportion of persons with high adherence at 1, 2, and 3 yr was 44%, 39%, and 35%, respectively. Among 65- to 78-yr-old persons with a physician diagnosis of osteoporosis, the crude and adjusted rate of hip fracture among the nonadherent was 1.96 (95% CI, 1.48-2.60) and 1.74 (95% CI, 1.30-2.31), respectively, resulting in a number needed to treat with high adherence to prevent one hip fracture of 107. The impact of high adherence was substantially less for other types of fractures and for younger persons. Analysis of adherence in a non-time-dependent fashion artifactually magnified differences in fracture rates between adherent and nonadherent persons. The antifracture effectiveness associated with high adherence to oral bisphosphonates varied substantially by age and fracture type. These results provide estimates of absolute fracture effectiveness across age subgroups and fracture types that have been minimally evaluated in clinical trials and may be useful for future cost-effectiveness studies.
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Hansen KE, Swenson ED, Baltz B, Schuna AA, Jones AN, Elliott ME. Adherence to alendronate in male veterans. Osteoporos Int 2008; 19:349-56. [PMID: 17898921 DOI: 10.1007/s00198-007-0471-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 08/07/2007] [Indexed: 11/26/2022]
Abstract
UNLABELLED In one Veterans Affairs' medical center, alendronate non-adherence was more likely in male veterans who smoke or report side effects, and less likely in men undergoing bone densitometry during therapy. Providers urgently need programs to increase adherence to osteoporosis medications. Initial programs should target patients with risk factors for non-adherence. INTRODUCTION Adherence to osteoporosis therapy in men is unknown. We hypothesized that ca. 50% of men at one center would be adherent to alendronate and one or more patient-specific factors would associate with adherence. METHODS We conducted a retrospective chart review study of male veterans to determine the rates and predictors of alendronate adherence over two years. We excluded women, men who received primary care elsewhere and those who took alendronate for indications other than low bone mass. We defined adherence as a medication possession ratio > or =80% in the first 24 months of therapy. RESULTS Adherence in the first 12 and 24 months of therapy was 59% and 54%, respectively. In multivariate analyses, non-adherence was more likely in men using tobacco (OR 2.08, 95% CI 1.13, 3.84, p = 0.02) and reporting side effects (OR 2.06, 95% CI 1.14, 3.73, p = 0.02) and less likely in men undergoing bone density during therapy (OR 0.49, 95% CI 0.26, 0.90, p = 0.02). CONCLUSIONS Alendronate non-adherence is more likely in male veterans who smoke or report side effects, and less likely in men having bone densitometry during therapy. Providers urgently need programs to increase adherence to osteoporosis medications. Initial programs should target patients with risk factors for non-adherence.
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Affiliation(s)
- K E Hansen
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
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22
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Romanholi DJ, Salgado LR. Síndrome de Cushing exógena e retirada de glicocorticóides. ACTA ACUST UNITED AC 2007; 51:1280-92. [DOI: 10.1590/s0004-27302007000800014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 08/21/2007] [Indexed: 11/22/2022]
Abstract
Glicocorticóides são amplamente utilizados na prática clínica para o controle da atividade de doenças auto-imunes, inflamatórias, alérgicas e outras entidades nosológicas. Doses terapêuticas de glicocorticóides são muita vezes administradas inapropriadamente e isto é um problema particular, pois a terapia crônica tem muitos efeitos colaterais que se estendem desde a supressão do eixo hipotálamo-hipofisário-adrenal e síndrome de Cushing até infecções e alterações do status mental. Fatores que influenciam tanto nos efeitos adversos quanto nos terapêuticos dos glicocorticóides incluem propriedades farmacocinéticas do glicocorticóide, dose diária, diferenças individuais no metabolismo esteróide e duração do tratamento. Quando utilizados para o controle da atividade destas doenças, quatro aspectos da retirada de glicocorticóide merecem atenção especial. Primeiro, a doença tratada pelo esteróide pode recorrer. Segundo, o eixo hipotálamo- hipófise-adrenal pode permanecer suprimido por um longo período. Terceiro, muitas vezes desenvolve-se dependência psicológica a esses hormônios. Quarto, uma síndrome de retirada inespecífica pode desenvolver mesmo enquanto os pacientes estão recebendo doses de reposição fisiológica de glicocorticóides. A gravidade da síndrome de retirada depende da fase e o grau de dependência e inclui sintomas tais como anorexia, náusea, vômitos, perda de peso, fadiga, mialgias, artralgias, cefaléia, dor abdominal, letargia, hipotensão postural, febre e descamação da pele.
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Ideguchi H, Ohno S, Hattori H, Ishigatsubo Y. Persistence with bisphosphonate therapy including treatment courses with multiple sequential bisphosphonates in the real world. Osteoporos Int 2007; 18:1421-7. [PMID: 17577595 DOI: 10.1007/s00198-007-0406-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 04/11/2007] [Indexed: 11/24/2022]
Abstract
UNLABELLED The real cumulative persistence probabilities with bisphosphonates after 5 years was 51.7%. Prescriptions by specialists other than gynecologists and rheumatologists (p < 0.001), male sex (p < 0.001), older age (> or =65 years) (p = 0.001), and cyclical etidronate (p < 0.001) were significantly associated with low persistence. Success rates of switching bisphosphonate were 75.6%. INTRODUCTION Many patients discontinue daily bisphosphonate therapy prematurely due to the stringent dosing procedures and adverse events. Consequently, some patients are receiving two or more sequential bisphosphonates in daily practice. Our objective was to study factors associated with the real cumulative persistence with bisphosphonate therapy including treatment courses with multiple sequential drugs in the real world setting. METHODS We retrospectively analyzed 1,307 patients (male 197, female 1110) newly prescribed with bisphosphonates between January 1, 2000, and June 30, 2005. RESULTS The real cumulative persistence probabilities with bisphosphonates after 1, 3, and 5 years were 74.8%, 60.6%, and 51.7%, respectively. Switching of bisphosphonates was observed 168 times in 146 patients. Adverse events occurred 126 times in 124 patients including 86 events with gastrointestinal complaints. Univariate analysis showed that prescriptions by specialists other than gynecologists and rheumatologists (p < 0.001), male sex (p < 0.001), older age (> or =65 years) (p = 0.001), and cyclical etidronate (p < 0.001) were significantly associated with low persistence. Success rates of switching bisphosphonate were 75.6%. CONCLUSIONS Switching of bisphosphonates was not uncommon. Despite switching bisphosphonates to improve persistence, the real cumulative persistence with bisphosphonate was suboptimal, especially among patients of certain physician specialties and male sex.
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Affiliation(s)
- H Ideguchi
- Chronic Intractable Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
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Spolidorio LC, Marcantonio E, Spolidorio DMP, Nassar CA, Nassar PO, Marcantonio RA, Rossa C. Alendronate therapy in cyclosporine-induced alveolar bone loss in rats. J Periodontal Res 2007; 42:466-73. [PMID: 17760825 DOI: 10.1111/j.1600-0765.2007.00970.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Cyclosporine A is an immunosuppressive drug that is widely used in organ transplant patients as well as to treat a number of autoimmune conditions. Bone loss is reported as a significant side-effect of cyclosporine A use because this can result in serious morbidity of the patients. As we have shown that cyclosporine A-associated bone loss can also affect the alveolar bone, the purpose of this study was to evaluate the effect of the concomitant administration of alendronate on alveolar bone loss in a rat model. MATERIAL AND METHODS Forty Wistar rats (10 per group) were given cyclosporine A (10 mg/kg, daily), alendronate (0.3 mg/kg, weekly), or both cyclosporine A and alendronate, for 60 d. The control group received daily injections of sterile saline. The expression of proteins associated with bone turnover, including osteocalcin, alkaline phosphatase and tartrate-resistant acid phosphatase (TRAP), and also the calcium levels, were evaluated in the serum. Analysis of the bone volume, alveolar bone surface, the number of osteoblasts per bone surface and the number of osteoclasts per bone surface around the lower first molars was also performed. RESULTS The results indicate that cyclosporine A treatment was associated with bone resorption, represented by a decrease in the bone volume, alveolar bone surface and the number of osteoblasts per bone surface and by an increase in the number of osteoclasts per bone surface and TRAP-5b. These effects were effectively counteracted by concomitant alendronate administration. CONCLUSION It is concluded that concomitant administration of alendronate can prevent cyclosporine A-associated alveolar bone loss.
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Affiliation(s)
- L C Spolidorio
- Department of Physiology and Pathology, Dental School of Araraquara, State University of São Paulo (UNESP), Araraquara, São Paulo, Brazil.
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Abstract
PURPOSE OF REVIEW Glucocorticoids are widely used, often long term, and a major side effect is osteoporosis and increased risk of fracture. This review considers how common is the problem, the patients who are most at risk, our current understanding of mechanisms, and how to prevent and effectively treat glucocorticoid-induced osteoporosis. The actions currently being undertaken in clinical practice are reviewed. RECENT FINDINGS Glucocorticoid-induced osteoporosis is an increasing problem that occurs not only in those on high-dose therapy. Advances in our knowledge of the cellular and cytokine mechanisms of bone turnover and glucocorticoid mechanisms of action are leading to a better understanding of how glucocorticoids affect bone cells and novel ways of prevention. Although there are effective treatments to prevent and control glucocorticoid-induced osteoporosis as well as guidelines for their use, they are still not being applied in routine clinical practice. SUMMARY Glucocorticoid-induced osteoporosis is a significant problem. Although our understanding of effective prevention and treatment strategies is improving, there needs to be better implementation of these strategies.
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Affiliation(s)
- Anthony D Woolf
- Institute of Health and Social Care Research, Peninsula Medical School, Universities of Exeter and Plymouth and Duchess of Cornwall Centre for Osteoporosis, Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
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26
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Compston JE. Emerging consensus on prevention and treatment of glucocorticoid-induced osteoporosis. Curr Rheumatol Rep 2007; 9:78-84. [PMID: 17437672 DOI: 10.1007/s11926-007-0026-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Glucocorticoid-induced osteoporosis is a common but still relatively neglected problem, with a low level of awareness among primary and secondary care physicians. Fractures appear early after initiation of treatment, and effective prophylaxis requires primary prevention in those at high risk of fracture. Bisphosphonates are the treatment of choice, and calcium and vitamin D supplements are also indicated in the majority of individuals. Organized care programs together with the use of evidence-based guidelines have the potential to improve significantly the management of this serious complication of glucocorticoid therapy.
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Affiliation(s)
- Juliet E Compston
- University of Cambridge School of Clinical Medicine, and Addenbrooke's Hospital, Box 157, Cambridge CB2 2QQ, UK.
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27
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Abstract
Glucocorticoids continue to be used for many inflammatory diseases, and glucocorticoid-induced osteoporosis (GIOP) remains the most common secondary form of metabolic bone disease. Recent meta-analyses suggest that both active and native vitamin D can help maintain lumbar spine bone mineral density (BMD), particularly in patients receiving lower-dose glucocorticoid therapy. Recent randomized, controlled clinical trials have shown that oral bisphosphonates are superior to vitamin D in maintaining BMD and should be continued for as long as a person receives glucocorticoid treatment. Similar to the oral bisphosphonates, intravenous ibandronate has been shown to preserve BMD and also to significantly reduce vertebral fracture risk. Increasing evidence supports a role for parathyroid hormone to prevent or treat GIOP as well. Despite effective therapies, many at-risk patients fail to receive treatment for GIOP, and even among those who initiate treatment, half discontinue within 1 to 2 years. New approaches to evidence implementation are being tested to improve the quality of osteoporosis care and decrease fracture risk among long-term glucocorticoid users.
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Affiliation(s)
- Jeffrey R Curtis
- University of Alabama at Birmingham, FOT 840, 510 20th Street South, Birmingham, AL 35294, USA.
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Palonen KP, Saag KG. Improving the quality of clinical care for patients with osteoporosis. Expert Rev Pharmacoecon Outcomes Res 2006; 6:641-5. [PMID: 20528489 DOI: 10.1586/14737167.6.6.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteoporosis, leading to hip fractures and other fragility fractures, is prevalent in countries with a high life expectancy. Fractures have a high associated societal cost and disease burden. As a result, many countries have established screening guidelines for osteoporosis, especially targeting those at a higher risk. However, primary- and secondary-fracture prevention is currently suboptimal despite existence of effective medications. In addition, adherence to therapy is low. This special report outlines some of these challenges and evaluates different techniques for improving the quality of clinical care for patients with osteoporosis.
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Affiliation(s)
- Katri P Palonen
- Summit Medical Center, Summit Medical Associates, PC, Hermitage, TN, USA.
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