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AlAnazi SM, AlKhamali AA, AlAteeq MA. Practice of Family Physicians in the Management of Osteoporosis Among Older Female Patients at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Cureus 2022; 14:e22387. [PMID: 35371702 PMCID: PMC8936228 DOI: 10.7759/cureus.22387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Osteoporosis is one of the major worldwide health concerns and carries medical, social, and financial impacts due to its significant morbidity and mortality. The aim of this study was to explore the practice of family physicians in osteoporosis management in older female patients. Method This study was performed in a cross-sectional manner. Data, including patient and disease characteristics and management practices, were obtained from the electronic patient chart for female patients aged 60 years and older who were followed in family medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the period from January 1, 2018, to December 31, 2020. Management was checked and evaluated against osteoporosis management guidelines. Results In 42 patients out of 250, an osteoporosis diagnosis was missed. Among the 208 charts that were reviewed, the mean patient age was 72.06 years, and the mean duration of the disease according to the initial dual-energy X-ray absorptiometry (DXA) scan was 3.68 years. Laboratory tests were performed for only about half of the patients. Vitamin D was given only to 54.3% while calcium supplements were given only to 53.4%. Almost one-third of the patients have not been prescribed any antiosteoporosis medications. Conclusion The current study documented that older females with osteoporosis were not well-managed in the investigated family medicine settings. Continuous professional development activities and periodic practice reviews are suggested to improve this situation.
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Stuart AL, Pasco JA, Mohebbi M, Kotowicz MA, Holloway-Kew KL, Hosking SM, Williams LJ. Osteoporosis medication use among Australian women over two decades. Arch Osteoporos 2020; 15:67. [PMID: 32372368 DOI: 10.1007/s11657-019-0661-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/17/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Despite the burden of osteoporosis and treatment availability, a treatment gap remains. Women in a population-based study were followed with respect to use of anti-fracture medication over two decades. Use increased over time but remained suboptimal, with less than 20% of those at high risk of fracture receiving treatment. PURPOSE We examined trends in osteoporosis-related medication use over time using data from the Geelong Osteoporosis Study, an ongoing, population-based study. METHODS Self-reported medication use data were available for 822 women (50-90 years) at time-1 (1993-1997), 575 women at time-2 (2004-2008), and 527 women at time-3 (2011-2014) participating in a longitudinal study. Prevalence of any osteoporosis-related medication use (pooled anti-fracture (bisphosphonates, raloxifene, denosumab, or strontium); hormone therapy; and supplements (calcium and/or vitamin D)) was calculated using bootstrapping methods for the whole group and those at risk of fracture, identified using FRAX Aus® (probability of major osteoporotic fracture ≥ 20% and/or ≥ 3% hip fracture) and BMD (osteoporosis indicated by a T-score of less than - 2.5 at either the femoral neck or spine). Time trend (age groups 50-59, 60-69, 70-79, 80+ years) and time-point effects were evaluated using mixed effects logistic models. RESULTS The use of any osteoporosis-related medication increased over three time points (time-1, 25.9% (95% CI 23.1, 28.8); time-2, 32.5% (28.7, 36.3); time-3, 35.9% (31.9, 39.8)), driven by the use of supplements (time-1, 12.9% (95% CI 10.6, 15.1); time-2, 22.1% (18.8, 25.4); time-3, 30.9% (26.9, 35.5)) and anti-fracture medication (time-1, 0.9% (0.4, 1.6); time-2, 5.0% (3.3, 6.8); time-3, 4.4% (2.7, 6.3)). Women at high risk of fracture were identified by BMD (time-1, n = 231 (28.1%); time-2, n = 92 (16.0%); time-3, n = 51 (9.7%)) and FRAX criteria (time-1, n = 272 (33.1%); time-2, n = 105 (18.3%); time-3, n = 100 (19.0%)). The use of anti-fracture medication was low among these groups (BMD criteria: time-1, 1.7% (0.4, 3.7); time-2, 16.3% (8.7, 24.3); time-3, 15.7% (7.1, 26.1); FRAX criteria: time-1, 1.1% (0.0, 2.3); time-2, 18.1% (11.5, 25.5); time-3, 13.0% (6.5, 19.8)). CONCLUSION Use of anti-fracture medication among women at risk of fracture remained low over time. Investment into systems approaches to correct the treatment gap is warranted.
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Affiliation(s)
- Amanda L Stuart
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
| | - Julie A Pasco
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.,Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia.,University Hospital Geelong, Geelong, Australia
| | | | - Mark A Kotowicz
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.,Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia.,University Hospital Geelong, Geelong, Australia
| | - Kara L Holloway-Kew
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Sarah M Hosking
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Lana J Williams
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
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Chalitsios CV, Shaw DE, McKeever TM. A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England. NPJ Prim Care Respir Med 2020; 30:5. [PMID: 32054843 PMCID: PMC7018734 DOI: 10.1038/s41533-020-0162-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022] Open
Abstract
Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect negative binomial regression analysis. There was a rise in OCS and BP prescriptions of 55% and 1200% from 1998 to 2018, respectively. Of the 6586 included practices, the median (IQR) of OCS and BP prescriptions were 120.8 (84.8-160.4) and 107.7 (73.8-147.4) per 1000 patients, respectively. Asthma and chronic obstructive pulmonary disease (COPD) were significantly associated with OCS use (p < 0.0001), but only COPD was associated with BP use (p < 0.0001). Higher OCS prescribing rates were associated with higher BP prescribing rates (5th to 1st quintile-IRR = 1.99; 95% CI: 1.88-2.10). Practice list size, deprivation and advanced age were all associated with both drugs (p < 0.0001). In conclusion, although OCS use is positively associated with BP prescription, variation among practices and CCGs exists. The variation in prescribing suggests there is still a need to improve GIOP prevention.
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Affiliation(s)
| | - Dominick E Shaw
- NIHR Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Variations in osteoporosis medication utilization. A population-based ecological cross-sectional study in the region of Valencia, Spain. PLoS One 2018; 13:e0199086. [PMID: 29927952 PMCID: PMC6013112 DOI: 10.1371/journal.pone.0199086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 05/31/2018] [Indexed: 11/19/2022] Open
Abstract
Little is known about the contextual variability in osteoporosis medication utilization. Our aims were 1) to describe variations in utilization and spending on osteoporotic medication between the Primary Care Health Zones (PHZ) of the Valencia region, Spain, 2) to analyze observed variations using Small Area Variation Analysis methods, and 3) to quantify the influence of the specialized care level on variations in utilization. We conducted a population-based cross-sectional ecological study of expenditure and utilization of five therapeutic groups marketed as osteoporosis treatments in Spain in 2009. The unit of analysis was the PHZ (in total 240) nested in the 23 Hospital Healthcare Departments (HHD) of the region of Valencia, covering a population of about 4.9 million inhabitants. Drug utilization was measured by dispensed Defined Daily Dose per 1000 women aged 50 years old and over and day (DID) per PHZ and cost was measured by the annual osteoporosis drug cost per woman aged 50 and older as well as the average price of DDD (Defined Daily Dose) in each PHZ. We calculated Indirect Standardized Drug Utilization Ratios (ISR) and we used Spearman's correlation to analyze associations between the ISRs of the different therapies. The average osteoporosis drug consumption was 119.1 DID, ranging from 77.6 to 171.3 DID (2.2 times higher) between PHZs in the 5th and 95th percentiles. Annual expenditure also showed a two-fold variation among PHZs. Average prices of the DDD by therapeutic group showed very low or no variation, although they differed substantially among therapeutic groups. Regarding the standardized consumption of osteoporotic drugs, HHDs explained a substantial part (39%) of the variance among PHZs. In conclusion, there is considerable variability in the volume and choice of anti-osteoporotic treatments between PHZs. with HHDs explaining an important proportion of the variation in utilization. Interventions aimed at reducing variation to improve appropriate care should take into account both the PHZ and HHD levels of care.
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Sanfélix-Gimeno G, Librero-López J, Modroño-Riaño G, Peiró S, Rodríguez-Bernal CL. Variation in Antiosteoporotic Drug Prescribing and Spending Across Spain. A Population-Based Ecological Cross-Sectional Study. Front Pharmacol 2018; 9:342. [PMID: 29706889 PMCID: PMC5909183 DOI: 10.3389/fphar.2018.00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/23/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Evidence has shown that utilization of antiosteoporotic medications does not correspond with risk, and studies on other therapies have shown that adequacy of pharmaceutical prescribing might vary between regions. Nevertheless, very few studies have addressed the variability in osteoporotic drug consumption. We aimed to describe variations in pharmaceutical utilization and spending on osteoporotic drugs between Health Areas (HA) in Spain. Methods: Population-based cross-sectional ecological study of expenditure and utilization of the five therapeutic groups marketed for osteoporosis treatment in Spain in 2009. Small area variation analysis (SAVA) methods were used. The units of analysis were the 168 HA of 13 Spanish regions, including 7.2 million women aged 50 years and older. The main outcomes were the defined daily dose (DDD) per 1000 inhabitants and day (DDD/1000/Day) dispensed according to the pharmaceutical claims reimbursed, and the expenditure on antiosteoporotics at retail price per woman ≥50 years old and per year. Results: The average osteoporosis drug consumption was 116.8 DDD/1000W/Day, ranging from 78.5 to 158.7 DDD/1000W/Day between the HAs in the 5th and 95th percentiles. Seventy-five percent of the antiosteoporotics consumed was bisphosphonates, followed by raloxifene, strontium ranelate, calcitonins, and parathyroid hormones including teriparatide. Regarding variability by therapeutic groups, biphosphonates showed the lowest variation, while calcitonins and parathyroid hormones showed the highest variation. The annual expenditure on antiosteoporotics was €426.5 million, translating into an expenditure of €59.2 for each woman ≥50 years old and varying between €38.1 and €83.3 between HAs in the 5th and 95th percentiles. Biphosphonates, despite accounting for 79% of utilization, only represented 63% of total expenditure, while parathyroid hormones with only 1.6% of utilization accounted for 15% of the pharmaceutical spending. Conclusion: This study highlights a marked geographical variation in the prescription of antiosteoporotics, being more pronounced in the case of costly drugs such as parathyroid hormones. The differences in rates of prescribing explained almost all of the variance in drug spending, suggesting that the difference in prescription volume between territories, and not the price of the drugs, is the main source of variation in this setting. Data on geographical variation of prescription can help guide policy proposals for targeting areas with inadequate antiosteoporotic drug use.
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Affiliation(s)
- Gabriel Sanfélix-Gimeno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- *Correspondence: Gabriel Sanfélix-Gimeno,
| | - Julián Librero-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Centro de Investigación Biomédica del Gobierno de Navarra (Navarrabiomed), Edificio de Investigación, Pamplona, Spain
| | - Gracia Modroño-Riaño
- Servicio de Farmacia en Atención Primaria y Especializada, Gijón, Spain
- Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - Salvador Peiró
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Clara L. Rodríguez-Bernal
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Martín-Merino E, Huerta-Álvarez C, Prieto-Alhambra D, Álvarez-Gutiérrez A, Montero-Corominas D. Secular trends of use of anti-osteoporotic treatments in Spain: A population-based cohort study including over 1.5million people and more than 12years of follow-up. Bone 2017; 105:292-298. [PMID: 28890137 DOI: 10.1016/j.bone.2017.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 08/04/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Different regulatory actions for anti-osteoporotic medication (AOM) were taken during the last years, including marketing of new drugs, safety warnings, or restrictions on the indications. We aimed to characterise the secular trends of AOM use in Spain from 2001 to 2013. METHODS A cohort study using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP), was performed. BIFAP includes anonym records for 4million patients. Participants entered the study when aged ≥50years in 2001-2013 and after 1year of data available, and were followed to an AOM prescription (including alendronate, other bisphosphonates, SERM (selective estrogen receptor modulators), strontium ranelate, teriparatide or denosumab), death, lost or the end of December 2013. Prevalence (%) and incidence rate (IR/1000person-years (py)) of AOM users were computed by years and sex. RESULTS Out of 1.5million participants, 135,410 received AOM treatment during 2001-2013. Prevalence was 6.1% (women) and 1.1% (men), that increased from 2001 (2.0%) to 2009 (7.6%) to decrease thereafter. Out of them, 95,057 were incident. The IR was 24.90 (women) and 2.77 (men), that increased from 2001 (21.25 and 1.96) to 2007 (35.84 and 3.64), and decreased to 12.48 and 1.81 (2013). IRs were highest for bisphosphonates along the years (ranging 3.70-14.73 and 0.57-1.75 in women and men respectively), followed by SERM up to 2005 (6.51-9.02 and 0.06-0.07), and strontium ranelate from 2006 (4.66 and 0.45) to 2012 (2.05 and 0.26). IR for teriparatide increased from marketing in 2004 (0.10-1.01 and 0.02-0.29), as was denosumab from marketing in 2011 (0.03-2.64 and 0.09-0.15). CONCLUSIONS Population-based estimates of AOM use in Spain peaked in 2007-2009 and decreased thereafter, irrespective of age and sex. New treatments were ten times higher in women than men. Bisphosphonates were the most frequently prescribed class, followed by SERM in women before 2006, strontium otherwise till 2012, and denosumab in women or teriparatide in men in 2013. Changes in the osteoporosis criteria, fracture risk assessment strategies, and regulatory actions for AOM around the time, may explain that trend.
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Affiliation(s)
- Elisa Martín-Merino
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain.
| | - Consuelo Huerta-Álvarez
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; GREMPAL (Grup de REcerca en Malalties Prevalents de l'Aparell Locomotor) Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Álvarez-Gutiérrez
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Dolores Montero-Corominas
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
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van der Velde RY, Wyers CE, Teesselink E, Geusens PPMM, van den Bergh JPW, de Vries F, Cooper C, Harvey NC, van Staa TP. Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: Variation by age, sex, geographic location and ethnicity. Bone 2017; 94:50-55. [PMID: 27742502 PMCID: PMC5124498 DOI: 10.1016/j.bone.2016.10.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Given the expected increase in the number of patients with osteoporosis and fragility fractures it is important to have concise information on trends in prescription rates of anti-osteoporosis drugs (AOD). METHODS We undertook a retrospective observational study using the UK Clinical Practice Research Datalink (CPRD) in the UK between 1990 and 2012 in subjects 50years or older, stratified by age, sex, geographic region and ethnicity. Yearly prescription incidence rates of any AOD and of each specific AOD were calculated as the number of patients first prescribed these AODs per 10,000person-years (py). RESULTS In women, yearly rates of first prescription of any AOD increased from 1990 to 2006 (from 2.3 to 169.7 per 10,000py), followed by a plateau and a 12% decrease in the last three years. In men, a less steep increase from 1990 to 2007 (from 1.4 to 45.3 per 10,000py) was followed by a plateau from 2008 onwards. Yearly rates of first prescription of any AOD increased up to the age of 85-89years (248.9 per 10,000py in women and 119.3 in men). There were marked differences between ethnic groups and regions. Bisphosphonates were the most frequently prescribed AODs: etidronate till 2000, and then subsequently alendronate. CONCLUSION We have demonstrated marked secular changes in rates of anti-osteoporosis drug prescription over the last two decades. The plateau (and decrease amongst women) in rates in recent years, set against an ever ageing population, is worrying, suggesting that the well-documented care gap in osteoporosis treatment persists. The differences in prescription rates by geographic location and ethnicity raise intriguing questions in relation to underlying fracture rates, provision of care and health behaviour. SUMMARY We studied the prescription incidence of anti-osteoporosis drugs (AOD) from 1990 to 2012 in the UK CPRD. Overall AOD prescription incidence showed a strong increase from 1990 to 2006, followed by a plateau in both sexes and a decrease amongst women in the last three years.
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Affiliation(s)
- R Y van der Velde
- Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands; Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands; Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands
| | - E Teesselink
- Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - P P M M Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands; Biomedical Research Centre, Hasselt University, Agoralaan - gebouw D, 3590 Diepenbeek, Belgium
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands; Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands; Biomedical Research Centre, Hasselt University, Agoralaan - gebouw D, 3590 Diepenbeek, Belgium
| | - F de Vries
- Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T P van Staa
- Health eResearch Centre, University of Manchester, Manchester, UK; Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht 3508 TB, The Netherlands
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Wright E, Schofield PT, Molokhia M. Bisphosphonates and evidence for association with esophageal and gastric cancer: a systematic review and meta-analysis. BMJ Open 2015; 5:e007133. [PMID: 26644118 PMCID: PMC4680000 DOI: 10.1136/bmjopen-2014-007133] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Concerns have been raised about a possible link between bisphosphonate use, and in particular alendronate, and upper gastrointestinal (UGI) cancer. A number of epidemiological studies have been published with conflicting results. We conducted a systematic review and meta-analysis of observational studies, to determine the risk of esophageal and gastric cancer in users of bisphosphonates compared with non-users. DESIGN We searched PubMed, MEDLINE, EMBASE, Web of Knowledge and Cochrane Database of Systematic Reviews for studies investigating bisphosphonates and esophageal or gastric cancer. We calculated pooled ORs and 95% CIs for the risk of esophageal or gastric cancer in bisphosphonate users compared with non-users. We performed a sensitivity analysis of alendronate as this was the most common single drug studied and is also the most widely used in clinical practice. RESULTS 11 studies (from 10 papers) examining bisphosphonate exposure and UGI cancer (gastric and esophageal), met our inclusion criteria. All studies were retrospective, 6/11 (55%) case-control and 5/11(45%) cohort, and carried out using data from 5 longitudinal clinical databases. Combining 5 studies (1 from each database), we found no increased risk, OR 1.11 (95% CI 0.97 to 1.27) of esophageal cancer in bisphosphonate users compared with non-users and no increased risk of gastric cancer in bisphosphonate users, OR 0.96 (95% CI 0.82 to 1.12). CONCLUSION This is the fourth and most detailed meta-analysis on this topic. We have not identified any compelling evidence for a significantly raised risk of esophageal cancer or gastric cancer in male and female patients prescribed bisphosphonates.
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Affiliation(s)
- Ellen Wright
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Peter T Schofield
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mariam Molokhia
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Overuse and Underuse of Antiosteoporotic Treatments According to Highly Influential Osteoporosis Guidelines: A Population-Based Cross-Sectional Study in Spain. PLoS One 2015; 10:e0135475. [PMID: 26317872 PMCID: PMC4552751 DOI: 10.1371/journal.pone.0135475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022] Open
Abstract
Inappropriate prescribing of antiosteoporotic medications has been observed; however, the joint study of both overuse and underuse has barely been attempted. Spain, with its high utilization rates, constitutes a good example to assess differences in over and under use according to diverse highly-influential osteoporosis guidelines (HIOG) worldwide. We used data of a population-based cross-sectional study including 824 post-menopausal women ≥50 years old living in the city of Valencia, Spain and aimed to estimate the percentage of women eligible for treatment, and the proportion of overuse and underuse of antiosteoporotic treatment according to HIOG. The prevalence of antiosteoporotic treatment in postmenopausal women ≥ 50 in Valencia was 20.9% (95%CI:17.6–24.4). The type of antiosteoporotic drugs prescribed varied greatly depending on the medical specialty responsible of the initial prescription. When applying the HIOG, the percentage of women 50 and over who should be treated varied from less than 9% to over 44%. In real terms, from the approximately eight million women of 50 years old and over in Spain, the number eligible for treatment would range from 0.7 to 3.8 million, depending on the guideline used. A huge proportion of inappropriate treatments was found when applying these guidelines to the Spanish population, combining a high overuse (42–78% depending on the guideline used) and underuse (7–41%). In conclusion, we found that the pharmacological management of osteoporosis in women of 50 and over in this population combines an important overuse and, to a lesser extent, underuse, although the level of inappropriateness varied strikingly depending on the CPG used. It seems urgent to reduce treatment overuse without neglecting underuse, as is urgent an attempt to reach wider agreement worldwide regarding osteoporosis management, in order to facilitate appropriate treatment and development of policies to reduce effectively treatment inappropriateness.
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Klop C, Gibson-Smith D, Elders PJM, Welsing PMJ, Leufkens HGM, Harvey NC, Bijlsma JWJ, van Staa TP, de Vries F. Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000-2010. Osteoporos Int 2015; 26:1919-28. [PMID: 25963232 PMCID: PMC4483189 DOI: 10.1007/s00198-015-3098-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/03/2015] [Indexed: 12/16/2022]
Abstract
UNLABELLED The probability of initiating with anti-osteoporosis therapy increased from 7 % in 2000 to 46 % in 2010. This improvement was greater for patients over the age of 75 years. Men, those overweight, having dementia or exposed to antipsychotics, sedatives/hypnotics or opioid analgesics were significantly less likely to receive anti-osteoporosis drugs. INTRODUCTION The objective of this study was to examine trends and determinants of anti-osteoporosis drug prescribing after hip fracture in the UK between 2000 and 2010. METHODS Data were extracted from the UK Clinical Practice Research Datalink for patients ≥50 years who had a first hip fracture between 2000 and 2010 and who did not currently (≤6 months prior) receive anti-osteoporosis drugs (bisphosphonates, strontium ranelate, parathyroid hormone, calcitonin and raloxifene) (n = 27,542). The cumulative incidence probability of being prescribed anti-osteoporosis drugs within 1 year after hip fracture was estimated by Kaplan-Meier life-table analyses. Determinants for treatment initiation were estimated by Cox proportional hazards models. RESULTS The probability of being prescribed any anti-osteoporosis drug after hip fracture increased from 7 % in 2000 to 46 % in 2010. This trend was more marked in patients ≥75 years. The increase in prescribing of anti-osteoporosis drugs was complemented by a similar increase in vitamin D/calcium provision. Cumulative incidence of receiving anti-osteoporosis therapy was greater at any given point in time in women (8 % in 2000, 51 % in 2010) compared to men (4 % in 2000, 34 % in 2010). In addition to male gender, multivariable Cox regression identified reduced likelihood of receiving anti-osteoporosis drugs for those being overweight, having dementia and exposed to psychotropic drugs (antipsychotics, sedatives/hypnotics) or opioid analgesics. CONCLUSION Although the prescribing of anti-osteoporosis drugs after hip fracture has increased substantially since 2000, the overall rate remained inadequate, particularly in men. With the continuing increase in the absolute number of hip fractures, further research should be made into the barriers to optimise osteoporosis management.
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Affiliation(s)
- C. Klop
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - D. Gibson-Smith
- Department of Psychiatry/EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - P. J. M. Elders
- Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - P. M. J. Welsing
- Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. G. M. Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - N. C. Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - J. W. J. Bijlsma
- Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T.-P. van Staa
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
- Health eResearch Centre, University of Manchester, Manchester, UK
| | - F. de Vries
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- Maastricht University/CAPHRI, Maastricht, The Netherlands
- Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands
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