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Gold DT, Beckett T, Deal C, James AL, Mohseni M, McMillan A, Bailey T, Pearman L, Caminis J, Wang Y, Williams SA, Kernaghan JM. Treatment patterns in women with postmenopausal osteoporosis using abaloparatide: a real-world observational study. Osteoporos Int 2024:10.1007/s00198-024-07070-z. [PMID: 38653862 DOI: 10.1007/s00198-024-07070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
Review of medical records from 173 women with osteoporosis who received abaloparatide treatment revealed that 96.0% had at least one visit for osteoporosis management and 55.5% had medication support group access. The most common reasons for discontinuing treatment were financial (31.2%) and tolerability (22.8%). Most patients (64.8%) completed treatment as prescribed. PURPOSE Abaloparatide is approved for the treatment of women with postmenopausal osteoporosis at high risk for fracture. This study evaluated real-world treatment patterns for patients new to abaloparatide, regardless of osteoporosis treatment history. METHODS Data for patients with ≥ 1 prescription for abaloparatide were collected retrospectively from six academic and clinical practice settings across the US. RESULTS A total of 173 patients were enrolled (mean [SD] age, 69.8 [7.4] years). At the time of abaloparatide treatment initiation, 78.6% had received other osteoporosis medications. Mean (SD) time from discontinuation of osteoporosis medications prior to initiation of abaloparatide was 1.7 (3.2) years. Twenty-four months of follow-up data from the initiation date of abaloparatide was collected from 94.0% of patients and 6.0% of patients had 12-24 months of follow-up. During the follow-up period, 96.0% of patients had at least one visit for osteoporosis management and 55.5% had access to a medication support program. The median duration of therapy was 18.6 months and 105/162 (64.8%) completed abaloparatide treatment as prescribed. The most common reasons for treatment discontinuation were financial (31.2%) and tolerability (22.8%). Following completion of a course of treatment with abaloparatide, 82/162 (50.6%) patients transitioned to another osteoporosis medication. The median time between abaloparatide treatment course completion and the initiation of follow-on medication was 21 days. CONCLUSION Most patients completed treatment with abaloparatide as prescribed, and over half continued with an antiresorptive agent. This favorable conduct may be the result of regular follow-up visits and accessibility to both medication and patient support services.
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Affiliation(s)
- Deborah T Gold
- Departments of Psychiatry & Behavioral Sciences and Sociology, Duke University Medical Center, Durham, NC, USA
| | - Tammy Beckett
- Department of Orthopaedics, Orthopaedic Associates of Grand Rapids Research and Education Institute, Grand Rapids, MI, USA
| | - Chad Deal
- Department of Rheumatology, Center for Osteoporosis and Metabolic Bone Disease, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew L James
- Proactive Orthopaedics at Columbia Orthopaedic Group LLP, Adult Health CNS, Columbia, MO, USA
| | - Mahshid Mohseni
- Department of Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Abigail McMillan
- Observational Research Adelphi Real World, Bollington, Macclesfield, UK
| | - Tom Bailey
- Observational Research Adelphi Real World, Bollington, Macclesfield, UK
| | - Leny Pearman
- Global Medical Affairs, Radius Health, Inc, Boston, MA, USA
| | - John Caminis
- Global Medical Affairs, Radius Health, Inc, Boston, MA, USA
| | - Yamei Wang
- Biostatistics, Radius Health, Inc, Boston, MA, USA.
| | | | - Jacqueline M Kernaghan
- Osteoporosis Center of Delaware County, Prospect Health Access Network, Springfield, PA, USA
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Resciniti SM, Biesiekierski JR, Ghasem-Zadeh A, Moschonis G. The Effectiveness of a Lactobacilli-Based Probiotic Food Supplement on Bone Mineral Density and Bone Metabolism in Australian Early Postmenopausal Women: Protocol for a Double-Blind Randomized Placebo-Controlled Trial. Nutrients 2024; 16:1150. [PMID: 38674841 PMCID: PMC11055009 DOI: 10.3390/nu16081150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Osteoporosis affects one in three women over the age of 50 and results in fragility fractures. Oestrogen deficiency during and after menopause exacerbates bone loss, accounting for higher prevalence of fragility fractures in women. The gut microbiota (GM) has been proposed as a key regulator of bone health, as it performs vital functions such as immune regulation and biosynthesis of vitamins. Therefore, GM modulation via probiotic supplementation has been proposed as a target for potential therapeutic intervention to reduce bone loss. While promising results have been observed in mouse model studies, translation into human trials is limited. Here, we present the study protocol for a double-blind randomized controlled trial that aims to examine the effectiveness of three lactobacilli strains on volumetric bone mineral density (vBMD), trabecular, and cortical microstructure, as measured using High Resolution peripheral Quantitative Computed Tomography (HR-pQCT). The trial will randomize 124 healthy early postmenopausal women (up to 8 years from menopause) to receive either probiotic or placebo administered once daily for 12 months. Secondary outcomes will investigate the probiotics' effects on areal BMD and specific mechanistic biomarkers, including bone metabolism and inflammatory markers. The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12621000810819).
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Affiliation(s)
- Stephanie M. Resciniti
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Jessica R. Biesiekierski
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, VIC 3086, Australia;
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia;
| | - Ali Ghasem-Zadeh
- Department of Medicine and Endocrinology, Austin Health, The University of Melbourne, Heidelberg West, VIC 3081, Australia;
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, VIC 3086, Australia;
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3
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Alahmari MM, AlHilali AI, Thabet TA, Alshahrani MA, Mobasher WA, Al Mubarak DA, Alshamrani AM, Gohman RS, Alqarni SA, Alqahtani MM. Impact of Medication Adherence on Bone Mineral Density and Fracture Risk in Patients With Osteoporosis: A Systematic Review. Cureus 2023; 15:e42115. [PMID: 37602050 PMCID: PMC10436998 DOI: 10.7759/cureus.42115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Osteoporosis is a chronic, prevalent disease marked by decreased bone mass and changes in bone anatomy associated with significant morbidity. The management of osteoporosis necessitates long-term therapy for which patient adherence is of vital importance. In the present review, we aim to collect all potential evidence from relevant studies that reported the impact of medication adherence on bone mineral density and fracture risk in patients with osteoporosis. We have conducted both electronic and manual search strategies within the potential databases and included articles and reviews to find relevant studies. We have assessed the effects of osteoporotic medication adherence on fracture rates and bone mineral density. The study participants were divided into two groups, adherent and non-adherent. Studies from the year 2010-2023 were included. Final inclusion consisted of 14 studies that showed variation in adherence rates with only three studies reporting optimal adherence followed by two studies with nearly half adherent population while the rest of the studies reported low medication adherence. The highest adherence rate reported was 82% while the lowest was 8%. Among the included studies the fracture rates varied significantly. Decreased rates of fracture were observed in the adherent population however two of the included studies were contrary to these findings. Additionally, only three studies discussed the effect of adherence on bone mineral density. Lack of medication adherence is linked to an increased risk of fracture, and low bone mineral density, further associated with more severe complications as per the evidence from the literature. However, variation in the fracture rates as observed in our findings advocates the need for further research for the generalizability of results.
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Affiliation(s)
- Manea M Alahmari
- Department of Endocrinology and Diabetes, Muhayel General Hospital, Muhayel, SAU
| | - Ali I AlHilali
- Department of Endocrinology and Diabetes, Aseer Central Hospital, Abha, SAU
| | - Taef A Thabet
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | | | | | | | - Abdullah M Alshamrani
- Department of Endocrinology and Diabetes, Armed Forces Hospital Southern Region, Khamis Mushait, SAU
| | - Raghad S Gohman
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | - Seham A Alqarni
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
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4
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LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2022; 33:2049-2102. [PMID: 35478046 PMCID: PMC9546973 DOI: 10.1007/s00198-021-05900-y] [Citation(s) in RCA: 253] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) - formerly the National Osteoporosis Foundation - first published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician's Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued-sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above - 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.
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Affiliation(s)
- M. S. LeBoff
- grid.38142.3c000000041936754XBrigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115 USA
| | - S. L. Greenspan
- grid.412689.00000 0001 0650 7433University of Pittsburgh Medical Center, 1110 Kaufmann Building, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
| | - K. L. Insogna
- grid.47100.320000000419368710Yale School of Medicine, 333 Cedar St, New Haven, CT 06520 USA
| | - E. M. Lewiecki
- grid.266832.b0000 0001 2188 8502University of New Mexico Health Sciences Center, 300 Oak St NE, Albuquerque, NM 87106 USA
| | - K. G. Saag
- grid.265892.20000000106344187University of Alabama at Birmingham, 1720 2nd Avenue South, FOT 820, Birmingham, AL 35294 USA
| | - A. J. Singer
- grid.411663.70000 0000 8937 0972MedStar Georgetown University Hospital and Georgetown University Medical Center, 3800 Reservoir Road NW, 3rd Floor, Washington, DC 20007 USA
| | - E. S. Siris
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, 180 Fort Washington Ave, Suite 9-903, New York, NY 10032 USA
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5
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Billington EO, Mahajan A, Benham JL, Raman M. Effects of probiotics on bone mineral density and bone turnover: A systematic review. Crit Rev Food Sci Nutr 2021:1-12. [PMID: 34748440 DOI: 10.1080/10408398.2021.1998760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Probiotic supplements have been shown to improve bone health in animal models, although it remains uncertain whether these beneficial effects extend to humans. We undertook a systematic review of the literature to determine the effects of probiotic interventions on skeletal outcomes in postmenopausal women. MEDLINE, EMBASE, CENTRAL, and the Cochrane Database of Systematic Reviews were searched from inception to October 2020 for controlled trials comparing the effects of probiotic-containing supplements with placebo on bone mineral density (BMD) or bone turnover markers. Risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Of 338 records identified, six randomized, placebo-controlled trials (n = 632) were eligible for inclusion. All studies assessed postmenopausal women for durations of 6-12 months; three were considered to be at high risk of bias. Four studies examined Lactobacillus-containing probiotics, one assessed a proprietary blend of lactic acid bacteria, and one evaluated Bacillus subtilis. Effects of probiotic interventions on BMD were inconsistent, with the majority of studies demonstrating no benefit at the spine or hip. Probiotic effects on bone turnover markers were similarly heterogeneous. High quality studies are needed to determine whether probiotic interventions have a role in maintaining bone health in humans.
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Affiliation(s)
- Emma O Billington
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Amita Mahajan
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie L Benham
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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6
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Márquez Fosser S, Mahmoud N, Habib B, Weir DL, Chan F, El Halabieh R, Vachon J, Thakur M, Tran T, Bustillo M, Beauchamp C, Bonnici A, Buckeridge DL, Tamblyn R. Smart about medications (SAM): a digital solution to enhance medication management following hospital discharge. JAMIA Open 2021; 4:ooab037. [PMID: 34159299 PMCID: PMC8211568 DOI: 10.1093/jamiaopen/ooab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To outline the development of a software solution to improve medication management after hospital discharge, including its design, data sources, intrinsic features, and to evaluate the usability and the perception of use by end-users. Materials and Methods Patients were directly involved in the development using a User Center Design (UCD) approach. We conducted usability interviews prior to hospital discharge, before a user started using the application. A technology acceptance questionnaire was administered to evaluate user self-perception after 2 weeks of use. Results The following features were developed; pill identification, patient-friendly drug information leaflet, side effect checker, and interaction checker, adherence monitoring and alerts, weekly medication schedule, daily pill reminders, messaging service, and patient medication reviews. The usability interviews show a 98.3% total success rate for all features, severity (on a scale of 1–4) 1.4 (SD 0.79). Regarding the self-perception of use (1–7 agreement scale) the 3 highest-rated domains were: (1) perceived ease of use 5.65 (SD 2.02), (2) output quality 5.44 (SD 1.65), and (3) perceived usefulness 5.29 (SD 2.11). Discussion Many medication management apps solutions have been created and most of them have not been properly evaluated. SAM (Smart About Medications) includes the user perspective, integration between a province drug database and the pharmacist workflow in real time. Its features are not limited to maintaining a medication list through manual entry. Conclusion We can conclude after evaluation that the application is usable and has been self-perceived as easy to use by end-users. Future studies are required to assess the health benefits associated with its use.
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Affiliation(s)
- Santiago Márquez Fosser
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Nadar Mahmoud
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Fiona Chan
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Rola El Halabieh
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Jeanne Vachon
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Manish Thakur
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | | | - André Bonnici
- Pharmacy Department, McGill University Health Centre, Montreal, Canada
| | - David L Buckeridge
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montréal, Canada
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7
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Koller G, Goetz V, Vandermeer B, Homik J, McAlister FA, Kendler D, Ye C. Persistence and adherence to parenteral osteoporosis therapies: a systematic review. Osteoporos Int 2020; 31:2093-2102. [PMID: 32613409 DOI: 10.1007/s00198-020-05507-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
Osteoporosis is a chronic disease of low bone mass and fragility. Treatment is frequently compromised by suboptimal medication compliance causing increased morbidity. This review investigates adherence and persistence to parenteral osteoporosis therapies. Findings reveal parenteral medications requiring reduced dosing frequency have higher compliance than oral therapies. This systematic review examines real-world adherence to parenteral osteoporosis therapies. We searched PubMed, Medline, and EMBASE databases for English language observational studies that examined patient adherence and/or persistence to parenteral osteoporosis treatments (teriparatide sc, ibandronate iv, zoledronic acid iv, and denosumab sc) in adults with osteoporosis published up to September 2018. Studies with only self-reported adherence or persistence data and those with less than 20 patients were excluded. Quality assessment of included studies was completed using the Newcastle-Ottawa quality assessment scale (NOS). We identified 40 eligible studies. Teriparatide was examined in 29 studies, with persistence rates of 10-87% (median 55%) at 1 year and 10-69% (median 29.5%) at 2 years, and adherence rates of 21-89% (median 53%) at 1 year and 37-68% (median 40%) at 2 years. Ten studies of zoledronic acid reported persistence rates of 34-73% (median 42%) for second dose and 20-54% (median 35.8%) for third dose. Ten studies of ibandronate adherence reported and 2-year persistence rates of 31-58% (median 47.5%) in 1 year and 13-35% (median 25%) at 2 years, and adherence rates of 21-72% (median 47.3%) and 15-58% (median 36.5%) respectively. Denosumab was reported in 19 studies, with second (1 year) and fourth (2 year) dose persistence rates of 61-100% (median 81%) and 36-99% (median 45.5%). There is substantial heterogeneity in reports of persistence and adherence rates with parenteral osteoporosis therapies. Most of the published data are from short-term studies and evaluations of long-term adherence and persistence with parenteral therapies for osteoporosis are needed.
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Affiliation(s)
- G Koller
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada
| | - V Goetz
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada
| | - B Vandermeer
- Alberta Research Centre for Health Evidence, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J Homik
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada
| | - F A McAlister
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - D Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - C Ye
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada.
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8
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Fülling T, Bula P, Defèr A, Bonnaire FA. Dresdener Network Osteoporosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:438-446. [PMID: 32428959 DOI: 10.1055/a-1149-9588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE On a global scale the main focus of traumatological therapy lies in the treatment of unintentional injuries or victims of violence. People of all ages and through all economic groups can be affected. Due to demographic change in Western industrial countries, however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis is the most common bone disease in advanced age. Secondary prevention programs like the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals, however, the FLS is still relatively uncommon. This article will examine the question whether secondary prevention programs like FLS need to be established in the German health care system. This study aims at finding out, whether in the area of a medium sized German city there is a difference regarding the initiation of osteoporosis diagnosis and therapy between the regular aftercare by the general practitioner or the orthopedic surgeon and the aftercare by a specialist trained in osteology (Osteologe). MATERIALS AND METHODS For the open, randomized prospective study 70 patients with low energy fractures were recruited, who were older than 60 years and have been treated in our department. RESULTS 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%. Limited mobility and a high degree of organizational effort were the main reasons for early termination of the study. While in the group with regular aftercare, only 2 out of 29 patients received a specific osteoporosis treatment, in group who were directly transferred to a specialist trained in osteology 17 out of 29 patients received specific treatment. After re-evaluation of group with regular aftercare in 21 out of 29 cases a specific osteoporosis treatment was recommended. CONCLUSIONS It could be established that there is a significant diagnosis and treatment gap regarding the aftercare of patients with fractures caused by osteoporosis between general practitioners or orthopedic surgeons on the one hand and the specialists trained in osteology on the other hand. To improve the aftercare of fracture patients, cross sectoral networks with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be established in the German healthcare system.
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Affiliation(s)
- Tim Fülling
- Department of Trauma, Reconstructive and Hand Surgery, Dresden Municipal Hospital
| | - Philipp Bula
- Department of Trauma and Reconstructive Surgery, Orthopaedic, Plastic, Aesthetic and Hand Surgery, Gutersloh Municipal Hospital
| | | | - Felix Alois Bonnaire
- Department of Trauma, Reconstructive and Hand Surgery, Dresden Municipal Hospital
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9
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Giampà E, Di Bonito M, Ferretti V, Nuvoli G, Paoletti F, Piazzini M, Ranieri M, Tuveri MA, Vinicola V. Effects of alendronate and calcifediol compared to alendronate and cholecalciferol in osteoporotic patients. MINERVA ENDOCRINOL 2020; 44:344-350. [PMID: 31971357 DOI: 10.23736/s0391-1977.19.03052-9] [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
BACKGROUND Several formulations of vitamin D and alendronate are available for the treatment of osteoporosis. The objective of this study was to examine efficacy and safety of calcifediol (25(OH)D) compared to cholecalciferol (vitamin D3) and also the relationship between different formulations of alendronate and adverse reactions. METHODS We observed a population of women diagnosed with postmenopausal osteoporosis or osteopenia treated with alendronate 70 mg weekly associated to vitamin D3 or 25(OH)D at monthly total dose of 625 µg. Data collected both at baseline (T0) and at follow-up after at least 12 months of therapy (T1) were: demographic characteristics, BMI, full medical history, lumbar T-score, femur T-score, calcium, osteocalcin, alkaline phosphatase, PTH and vitamin D blood level. RESULTS A total of 362 patients were enrolled in the study. Alendronate 70 mg + calcifediol (A+25(OH)D) group consisted of 202 patients while 160 patients were treated with alendronate 70 mg + cholecalciferol (A+D3). In the A+25(OH)D group, we observed a significant increase in lumbar T-score value (0.26±0.35 vs. 0.13±0.3) and serum vitamin D (20.64±20.71 vs. 6.07±7.61 ng/mL) levels compared to the A+D3 group (P<0.05). The lowest incidence of gastrointestinal adverse reactions was observed among patients taking alendronate 70 mg in drinkable solution form (P<0.05). CONCLUSIONS Alendronate 70 mg with calcifediol gives a better outcome in the treatment of osteoporosis according to lumbar T-score and vitamin D serum level observed at one-year follow-up compared to alendronate 70 mg with cholecalciferol. Both vitamin D formulations did not show to cause hypercalcemia in this study. Alendronate 70 mg in drinkable solution form is also associated with lowest incidence of gastrointestinal adverse reactions.
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Affiliation(s)
| | | | | | | | - Franco Paoletti
- Service of Rheumatology, Azienda Sanitaria Regionale del Molise, S.F. Caracciolo Hospital, Agnone, Isernia, Italy
| | | | - Mauro Ranieri
- Presidio Territoriale di Assistenza Tagliacozzo, Tagliacozzo, L'Aquila, Italy
| | | | - Vincenzo Vinicola
- Ambulatory of Osteoporosis, Unit of Medicine, Santa Lucia Foundation, Rome, Italy
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10
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Bou Malham S, Bowe B, Sen SK, Zhang RM, Sterkel B, Dunn JP. Predictors and Outcomes Associated With Adherence to Weekly Alendronate in US Military Veterans: Clinical Research Study. J Prim Care Community Health 2019; 10:2150132719884300. [PMID: 31779523 PMCID: PMC6886269 DOI: 10.1177/2150132719884300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Poor adherence to oral bisphosphonates is a challenge to treatment and prevention of osteoporosis. The Veterans Health Administration (VA) operates the largest integrated health care system in the United States and offers certain advantages to possibly improve medication adherence. We aimed to determine adherence to weekly alendronate for osteoporosis in Veterans, and investigate predictors and outcomes related to adherence. Methods: A retrospective study cohort was generated from VA databases selecting Veterans who were treated with weekly alendronate. Adherence was measured by medication possession ratio (MPR) and persistence. Two groups were defined as low and high adherence based on MPR <80% or ≥80%, respectively. Regression models were used to investigate predictors of adherence and included clinically relevant covariates. Further regressions were used to investigate the impact of adherence on change in bone mineral density measured by dual energy X-ray absorptiometry and incident fracture. Results: In a cohort of 913 (female/male, 207/706) Veterans, 48% had high adherence in year 1. Distribution for gender, race, and age were similar between the 2 groups, MPR <80% or MPR ≥80%. Baseline fracture [odds ratio OR: 0.64, 95%CI: (0.41, 0.98)], alcohol abuse [0.40 (0.21, 0.74)] and tobacco use [0.44 (0.31, 0.63)] were associated with low adherence in the unadjusted analyses, but only tobacco use [0.45 (0.30, 0.67)] was associated with low adherence after adjustment. Among males, tobacco use was associated with low adherence while prostate cancer predicted high adherence in adjusted models. High adherence was associated with a 30% [hazard ratio HR: 0.70, 95% CI: (0.47, 1.03)] decreased risk of incident fracture in the whole cohort, and a 40% [0.60 (0.38, 0.95)] decrease risk in males. Conclusion: Year one adherence to weekly alendronate was a relevant determinant to long-term clinical outcomes including changes in bone mineral density and incident fracture in Veterans.
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Affiliation(s)
- Sarah Bou Malham
- Washington University in St Louis, St Louis, MO, USA.,Hennepin Healthcare, Minneapolis, MN, USA
| | - Benjamin Bowe
- Veterans Affairs St Louis Health Care System, St Louis, MO, USA.,St Louis University, St Louis, MO, USA
| | - Sumon K Sen
- Veterans Affairs St Louis Health Care System, St Louis, MO, USA
| | - Rong Mei Zhang
- Washington University in St Louis, St Louis, MO, USA.,St Louis University, St Louis, MO, USA
| | - Barbara Sterkel
- Veterans Affairs St Louis Health Care System, St Louis, MO, USA
| | - Julia P Dunn
- Washington University in St Louis, St Louis, MO, USA.,Veterans Affairs St Louis Health Care System, St Louis, MO, USA
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11
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Jansson PA, Curiac D, Lazou Ahrén I, Hansson F, Martinsson Niskanen T, Sjögren K, Ohlsson C. Probiotic treatment using a mix of three Lactobacillus strains for lumbar spine bone loss in postmenopausal women: a randomised, double-blind, placebo-controlled, multicentre trial. THE LANCET. RHEUMATOLOGY 2019; 1:e154-e162. [PMID: 38229392 DOI: 10.1016/s2665-9913(19)30068-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Postmenopausal bone loss in the spine is associated with an increased risk of vertebral fractures. Certain probiotic treatment protects rodents from ovariectomy-induced bone loss. The aim of the present study was to determine if treatment with a combination of three bacterial strains protects against the rapid spine bone loss occurring in healthy early postmenopausal women. METHODS This randomised, double-blind, placebo-controlled, multicentre trial was done at four study centres in Sweden. Early postmenopausal women were randomly assigned in a 1:1 ratio to receive probiotic treatment consisting of three Lactobacillus strains (Lactobacillus paracasei DSM 13434, Lactobacillus plantarum DSM 15312, and Lactobacillus plantarum DSM 15313; 1 x 1010 colony-forming units per capsule) or placebo once daily for 12 months. The primary outcome was the percentage change from baseline in lumbar spine bone mineral density (LS-BMD) at 12 months. The primary analysis was done in all participants with BMD measurements available both at baseline and at 12 months. Analyses of adverse events and safety included all participants who had taken at least one capsule of placebo or Lactobacillus. This trial is registered with ClinicalTrials.gov, NCT02722980, and is completed. FINDINGS Between April 18 and Nov 11, 2016, 249 participants were randomly assigned to receive probiotic product or placebo, and 234 (94%) completed the analyses required for the primary outcome. Lactobacillus treatment reduced the LS-BMD loss compared with placebo (mean difference 0·71%, 95% CI 0·06 to 1·35). The LS-BMD loss was significant in the placebo group (-0·72%, -1·22 to -0·22), whereas no bone loss was observed in the Lactobacillus-treated group (-0·01%, -0·50 to 0·48). The adverse events were similar between the two groups. INTERPRETATION Probiotic treatment using a mix of three Lactobacillus strains protects against lumbar spine bone loss in healthy postmenopausal women. FUNDING Probi.
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Affiliation(s)
- Per-Anders Jansson
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Curiac
- CTC, Gothia Forum, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | - Klara Sjögren
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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12
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Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. Br J Clin Pharmacol 2019; 85:2464-2478. [PMID: 31486099 PMCID: PMC6848955 DOI: 10.1111/bcp.14075] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/03/2019] [Accepted: 07/12/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this systematic review and meta-analysis was to synthesise the evidence relating to medication non-adherence and its association with health outcomes in people aged ≥50 years. METHODS Seven databases were searched up to February 2019 for observational studies that measured medication (non-)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). RESULTS Sixty-six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta-analyses. A meta-analysis including 3 studies measuring medication non-adherence in adults aged ≥55 years showed a significant association with all-cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta-analysis including 2 studies showed that medication non-adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long-term mortality risk in comparison to medication non-adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). CONCLUSION Medication non-adherence may be significantly associated with all-cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.
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Affiliation(s)
- Caroline A. Walsh
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Caitriona Cahir
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Sarah Tecklenborg
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | - Catherine Byrne
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
| | | | - Kathleen E. Bennett
- Division of Population Health SciencesRoyal College of Surgeons in IrelandDublinIreland
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13
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Hiligsmann M, Williams SA, Fitzpatrick LA, Silverman SS, Weiss R, Reginster JY. Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture. Semin Arthritis Rheum 2019; 49:184-196. [DOI: 10.1016/j.semarthrit.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/20/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022]
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14
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Association between adherence to antihypertensive medications and health outcomes in middle and older aged community dwelling adults; results from the Irish longitudinal study on ageing. Eur J Clin Pharmacol 2019; 75:1283-1292. [PMID: 31190134 DOI: 10.1007/s00228-019-02699-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the association between antihypertensive medication (AHTM) implementation adherence and healthcare utilisation in community-dwelling adults aged ≥ 50 years in Ireland. METHODS This was a prospective cohort study. The Irish Longitudinal Study on Ageing (TILDA) was linked to pharmacy claims data for participants aged ≥ 50 years. Participants were included if they had ≥ 3 pharmacy claims for one or more AHTM (ATC codes 'C02', 'C03', 'C07', 'C08' or 'C09') within the year preceding the year of self-reported healthcare utilisation outcome occurrence. Outcomes included self-reported general practitioner (GP), emergency department (ED), outpatient department visits and hospital admissions. Implementation adherence was measured using proportion of days covered (PDC), with participants classified as adherent if the average PDC ≥ 0.8. Negative binomial models were used to analyse the association between AHTM adherence and number of GP, ED, outpatient visits and hospitalisations (adjusted IRR and 95% CI are presented). RESULTS One thousand four hundred thirty-one participants were included. The majority of participants (72.6%) were considered adherent. Good implementation adherence to AHTM was associated with a significant decrease in self-reported GP visits (adjusted IRR 0.91, 95% CI 0.83-0.99). Adherence had no significant impact on the number of ED visits, outpatient visits or hospitalisations reported by TILDA participants. CONCLUSIONS Good adherence to AHTM was associated with less self-reported GP visits in this population, suggesting improved overall health status. However, the impact of medication non-adherence on the other self-reported healthcare utilisation outcomes (ED, outpatient visits and hospitalisations) was not evident in this study.
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15
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Guiducci L, Vassalle C, Parchi P, Maffei S. Monthly Intramuscular Neridronate for the Treatment of Postmenopausal Osteoporosis: Results of a 6-Year Prospective Italian Study. Int J Endocrinol 2019; 2019:9802827. [PMID: 30881452 PMCID: PMC6381585 DOI: 10.1155/2019/9802827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Oral bisphosphonates (BPs) are the most commonly used medications for osteoporosis (OP), but their poor gastrointestinal (GI) absorption and tolerance hamper compliance. Intramuscular (IM) neridronate (NE), an amino-BP, is an easy-to-administer, effective, and safe alternative to oral BPs. We assessed the 6-year effects of monthly IM NE on bone mineral density (BMD) and bone turnover biomarkers (BMs) in postmenopausal OP. METHODS This single-center, prospective study enrolled postmenopausal osteoporotic outpatients with gastric intolerance to BPs (based on Tuscany Region's law GRT n. 836 20/10/2008). They received 25 mg IM NE once a month (with vitamin D and calcium if necessary) for 6 years. BMD was evaluated at lumbar spine (L1-L4), femoral neck (FN), and total femur (TF) at baseline (BL) and every 12 months afterwards. At BL, month 3, and every 12 months after BL, total and ionized calcium, vitamin D, parathyroid hormone 1-84, bone alkaline phosphatase (BALP), osteocalcin, and N- and C-terminal telopeptides were assayed. RESULTS Overall, 60 women (mean age: 62.3 ± 7.5 years) received monthly IM NE for 6 years, with vitamin D and calcium supplementation in 81.3% of cases. Compared to BL, BMD increased significantly already after 1 year at all sites (4.5 ± 0.9% for L1-L4, 4.5 ± 0.8% for TF, and 2.1 ± 0.6% for FN, P ≤ 0.05), and the changes were maintained over time, whereas FN further improved up to year 3 and remained stable afterwards (P ≤ 0.05). All BMs, except for total calcium and BALP, progressively decreased over time (P ≤ 0.05). No fractures and significant adverse events were reported. CONCLUSION The monthly administration of IM NE represents a manageable and effective option, in terms of BMD and bone BM improvement, for the long-term treatment of postmenopausal OP women with gastric intolerance to BPs. This trial is registered with ClinicalTrials.gov Identifier: NCT03699150.
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Affiliation(s)
- L. Guiducci
- Institute of Clinical Physiology, CNR National Research Council, Pisa, Italy
| | - C. Vassalle
- CNR-Regione Toscana G Monasterio Foundation, Pisa, Italy
| | - P. Parchi
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - S. Maffei
- CNR-Regione Toscana G Monasterio Foundation, Pisa, Italy
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16
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Nilsson AG, Sundh D, Bäckhed F, Lorentzon M. Lactobacillus reuteri reduces bone loss in older women with low bone mineral density: a randomized, placebo-controlled, double-blind, clinical trial. J Intern Med 2018; 284:307-317. [PMID: 29926979 DOI: 10.1111/joim.12805] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The importance of the gut microbiome for bone metabolism in mice has recently been demonstrated, but no studies are available in humans. Lactobacillus reuteri ATCCPTA 6475 (L. reuteri 6475) has been reported to increase bone mineral density (BMD) in mice but its effect on the human skeleton is unknown. The objective of this trial was to investigate if L. reuteri 6475 affects bone loss in older women with low BMD. METHODS In this double-blind, placebo-controlled study, women from the population who were 75 to 80 years old and had low BMD were randomized to orally receive 1010 colony-forming units of L. reuteri 6475 daily or placebo. The predefined primary end-point was relative change after 12 months in tibia total volumetric BMD (vBMD). RESULTS Ninety women were included and 70 completed the study. L. reuteri 6475 reduced loss of total vBMD compared to placebo both in the intention-to-treat (ITT) analysis [-0.83% (95% confidence interval [CI], -1.47 to -0.19%) vs. -1.85% (95% CI, -2.64 to -1.07%); mean difference 1.02% (95% CI, 0.02-2.03)] and per protocol analysis [-0.93% (95% CI, -1.45 to -0.40) vs. -1.86% (95% CI, -2.35 to -1.36); mean difference 0.93% (95% CI, 0.21-1.65)]. In general, similar but smaller effects were observed in the secondary bone variable outcomes, but these differences did not reach statistical significance in the ITT population. Adverse events did not differ between groups. CONCLUSIONS Supplementation with L. reuteri 6475 should be further explored as a novel approach to prevent age-associated bone loss and osteoporosis.
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Affiliation(s)
- A G Nilsson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Internal Medicine, Sahlgrenska University Hospital, Gothenburg and Mölndal, Sweden
| | - D Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - F Bäckhed
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine Clinic, Sahlgrenska University Hospital, Gothenburg and Mölndal, Sweden
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17
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Elsayed R, Abraham P, Awad ME, Kurago Z, Baladhandayutham B, Whitford GM, Pashley DH, McKenna CE, Elsalanty ME. Removal of matrix-bound zoledronate prevents post-extraction osteonecrosis of the jaw by rescuing osteoclast function. Bone 2018; 110:141-149. [PMID: 29408511 PMCID: PMC5878730 DOI: 10.1016/j.bone.2018.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/06/2018] [Accepted: 01/25/2018] [Indexed: 12/25/2022]
Abstract
Unlike other antiresorptive medications, bisphosphonate molecules accumulate in the bone matrix. Previous studies of side-effects of anti-resorptive treatment focused mainly on systemic effects. We hypothesize that matrix-bound bisphosphonate molecules contribute to the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this study, we examined the effect of matrix-bound bisphosphonates on osteoclast differentiation in vitro using TRAP staining and resorption assay, with and without pretreatment with EDTA. We also tested the effect of zoledronate chelation on the healing of post-extraction defect in rats. Our results confirmed that bisphosphonates bind to, and can be chelated from, mineralized matrix in vitro in a dose-dependent manner. Matrix-bound bisphosphonates impaired the differentiation of osteoclasts, evidenced by TRAP activity and resorption assay. Zoledronate-treated rats that underwent bilateral dental extraction with unilateral EDTA treatment showed significant improvement in mucosal healing and micro-CT analysis on the chelated sides. The results suggest that matrix-bound bisphosphonates are accessible to osteoclasts and chelating agents and contribute to the pathogenesis of BRONJ. The use of topical chelating agents is a promising strategy for the prevention of BRONJ following dental procedures in bisphosphonate-treated patients.
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Affiliation(s)
- Ranya Elsayed
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Pheba Abraham
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mohamed E Awad
- Department of Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Zoya Kurago
- Department of Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Gary M Whitford
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - David H Pashley
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Charles E McKenna
- Department of Chemistry, Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Mohammed E Elsalanty
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA.
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18
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Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open 2018; 8:e016982. [PMID: 29358417 PMCID: PMC5780689 DOI: 10.1136/bmjopen-2017-016982] [Citation(s) in RCA: 443] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine the economic impact of medication non-adherence across multiple disease groups. DESIGN Systematic review. EVIDENCE REVIEW A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist. RESULTS Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents. CONCLUSION Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required. PROSPERO REGISTRATION NUMBER CRD42015027338.
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Affiliation(s)
- Rachelle Louise Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy Faculty of Pharmacy, Research Institute for Medicines (iMed.ULisboa), University of Lisbon, Lisbon, Portugal
| | - Michael Frommer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Charlie Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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19
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Chen PH, Lin MS, Huang TJ, Chen MY. Prevalence of and factors associated with adopting bone health promoting behaviours among people with osteoporosis in Taiwan: a cross-sectional study. BMJ Open 2017; 7:e015980. [PMID: 28951404 PMCID: PMC5623584 DOI: 10.1136/bmjopen-2017-015980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To detect osteopenia, osteoporosis, treatments received and bone health promoting behaviours early among postmenopausal women and elderly men, and to explore the associated factors. DESIGN A community-based cross-sectional study. SETTINGS Two rural townships in Yunlin County, Taiwan. PARTICIPANTS A total of 941 adults including 651 postmenopausal women and 290 elderly men aged >65 years. OUTCOME MEASURES Bone mineral density was measured using dual-energy X-ray absorptiometry. Adults with a T-score <-1.0 for bone mineral density were classified as having osteopenia, and those with a T-score <-2.5 as having osteoporosis. The main outcome measures were prevalence of osteopenia, osteoporosis, receiving medication and bone health promoting behaviours. A logistic regression model was used to analyse the factors associated with adopting bone health promoting behaviours. RESULTS Across both genders, 63.7% of participants were identified as having osteopenia (46.9%) or osteoporosis (16.8%). A high proportion of participants reported never or seldom performing regular exercise, or having sunlight exposure, a diet containing calcium/vitamin D or taking medications/supplements for bone health. Although 34.8% reported taking supplements, 92.4% were inadequate. The logistic regression model indicated that older age (OR 1.03, 95% CI 1.01 to 1.05, p=0.006) and a high education level (OR 1.07, 95% CI 1.03 to 1.11, p<0.001) were significant factors associated with bone health promoting behaviours. CONCLUSION The prevalence of osteopenia and osteoporosis among postmenopausal women and elderly men is worryingly high and most of them receive inadequate treatment and perform few bone health promoting behaviours. Interventions are therefore urgently required to address the right methods for delaying osteoporosis among postmenopausal women and elderly men in rural areas.
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Affiliation(s)
- Po-Han Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Tung-Jung Huang
- Department of Chest, Chang Gung Memorial Hospital, Yunlin, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Yunlin, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
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20
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van der Zwaard BC, van Hout W, Hugtenburg JG, van der Horst HE, Elders PJM. Adherence and persistence of patients using oral bone sparing drugs in primary care. Fam Pract 2017; 34:525-531. [PMID: 28334908 DOI: 10.1093/fampra/cmw120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM Studies based on pharmacy medication records have shown suboptimal adherence and persistence of osteoporosis treatment with oral bone sparing drugs (OBSD). Little is known about adherence and persistence of OBSD treatment in primary care. We assessed adherence and persistence of OBSD use of patients in general practices and identified associated factors. METHODS Using electronic medical records, adherence and persistence of newly prescribed treatment with OBSD in patients from 16 general practices was retrospectively assessed. The Medication Possession Ratio (MPR) was calculated as a proxy for adherence (MPR > 75%), persistence rates were estimated using survival analysis. Determinants of adherence and persistence using logistic regression and Cox regression analysis were assessed. RESULTS OBSD treatment was initiated in 957 patients. Seventy-five percent and 45% of the patients persisted OBSD treatment for one and five years, respectively. Being adherent in the first year decreased the risk of long-term non-persistence [hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.3-0.57; P < 0.001]. Patients receiving the majority of their prescriptions by a specialist tended to be more non-persistent (HR 1.37; 96%; CI 0.96-1.94; P = 0.08). Adherence was 62.5% in the first year and 60.8% in the overall treatment period. Non-adherence was associated with the specialist being the main prescriber [odds ratio (OR) 3.76; 95% CI 2.43-5.82; P < 0.001] and younger age (<65 years, OR 1.44; 95% CI 1.01-2.08; P = 0.04). CONCLUSION Older age of the patients and the GP prescribing the majority of medication were associated with better adherence and persistence. Good adherence in the first prescription year was associated with better persistence.
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Affiliation(s)
- Babette C van der Zwaard
- Department of General Practice and Elderly Care Medicine,VU University Medical Center, Amsterdam, The Netherlands
| | - Wesley van Hout
- Department of General Practice and Elderly Care Medicine,VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of General Practice and Elderly Care Medicine,VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine,VU University Medical Center, Amsterdam, The Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine,VU University Medical Center, Amsterdam, The Netherlands
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21
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Hui RL, Adams AL, Niu F, Ettinger B, Yi DK, Chandra M, Lo JC. Predicting Adherence and Persistence with Oral Bisphosphonate Therapy in an Integrated Health Care Delivery System. J Manag Care Spec Pharm 2017; 23:503-512. [PMID: 28345435 PMCID: PMC5641482 DOI: 10.18553/jmcp.2017.23.4.503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Examining drug exposure is essential to pharmacovigilance, especially for bisphosphonate (BP) therapy. OBJECTIVE To examine differences in 4 measures of oral BP exposure: treatment discontinuation, adherence, persistence, and nonpersistence. METHODS Among women aged ≥ 50 years who initiated oral BP therapy during 2002-2007 with at least 3 years of health plan membership follow-up, discontinuation was defined by evidence of no further treatment during the study observation period. Among those with at least 2 filled BP prescriptions during the study period, adherence was calculated for each year of follow-up using the (modified) proportion of days covered (mPDC) metric that allows for stockpiling of prescription/refills overlap ≤ 30 days supply. Persistence was quantified by treatment duration, allowing a gap of up to 60 days between prescription/refill days covered. Nonpersistence was quantified by the periods without drugs outside this allowable gap. Multivariable logistic regression was used to compare age and race groups and the relationships of early adherence (adherence during the first year) with subsequent adherence. RESULTS Among 48,390 women initiating oral BP therapy and followed for 3 years, 26.7% discontinued in year 1, and 14.7% of the remaining 35,456 women discontinued in year 2. Discontinuation rates were slightly higher (29.4%, P < 0.001) for women aged ≥ 75 years and somewhat lower (21.1%, P < 0.001) for Asian women. During the first year, 60.4% of the women achieved an mPDC of ≥ 75%, with demographic differences in adherence similar to that seen for treatment discontinuation. Over the 3 years, the median mPDC levels for BP therapy were 86%, 84%, and 85% in years 1, 2, and 3, respectively, for those receiving treatment. Cumulative persistence was 2.3 years (median, IQR = 1.0-3.0) overall and slightly greater for Asian versus white women and lower for older women. There were 18,174 (42.9%) women with at least 1 period of nonpersistence during 3 years follow-up in excess of the 60-day allowable gap between prescription/refills (median cumulative nonpersistence = 0.65, IQR = 0.30-1.25 years). Women with mPDC ≥ 75% during the first year had a 12-fold and 6-fold increased odds of mPDC ≥ 75% during year 2 and year 3, respectively. CONCLUSIONS BP discontinuation rates are highest for women during the first year. Among those continuing treatment in subsequent years, adherence rates were relatively stable. Persistence and adherence varied slightly by age and was somewhat higher in Asians, contributing to differences in cumulative BP exposure. We also found evidence that optimal adherence in the first year was highly predictive of optimal adherence in the subsequent 1-2 years. Hence, subgroups of patients receiving oral BP drugs may require different levels of support and monitoring to maximize treatment benefit, especially based on early patterns of use. DISCLOSURES This study was supported by grants from the Kaiser Permanente Northern California Community Benefit Program and the National Institutes of Health, 1R01AG047230-01A1. The opinions expressed in this publication are solely the responsibility of the authors and do not represent the official views of Kaiser Permanente or the National Institutes of Health. Hui, Yi, and Chandra have received past research funding from Amgen not related to the current study. Adams has received research funding from Amgen, Merck, and Otsuka not related to the current study. Niu has received research funding from Bristol-Myers Squibb not related to the current study. Ettinger has received past legal fees in litigation involving Fosamax. Lo has received past research funding from Amgen and current research funding from Sanofi not related to the current study. The data from this study were presented at the Academy of Managed Care Pharmacy Annual Meeting; April 19-22, 2016; San Francisco, California. Study concept and design were contributed primarily by Hui and Lo, along with Adams, Niu, Yi, and Ettinger. Hui took the lead in data collection, along with Chandra, and data interpretation was performed by Niu, Yi, and Lo, along with the other authors. The manuscript was written by Hui, Adams, and Lo, along with Niu, Yi, and Ettinger, and revised by Ettinger, Hui, Lo, and Niu, along with the other authors.
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Affiliation(s)
- Rita L Hui
- 1 Pharmacy Outcomes Research Group, Kaiser Permanente California, Oakland
| | - Annette L Adams
- 3 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Fang Niu
- 4 Pharmacy Outcomes Research Group, Kaiser Permanente California, Downey
| | - Bruce Ettinger
- 2 Division of Research, Kaiser Permanente Northern California, Oakland
| | - David K Yi
- 3 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Malini Chandra
- 2 Division of Research, Kaiser Permanente Northern California, Oakland
| | - Joan C Lo
- 2 Division of Research, Kaiser Permanente Northern California, Oakland
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Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain. Br J Gen Pract 2017; 67:e614-e622. [PMID: 28760740 DOI: 10.3399/bjgp17x692129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/05/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave. AIM To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups. DESIGN AND SETTING A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012. METHOD Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre. RESULTS Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term. CONCLUSION Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.
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Tratamento da osteoporose pós‐menopáusica: um algoritmo baseado na literatura para uso no sistema público de saúde. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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24
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Caires ELP, Bezerra MC, Junqueira AFTDA, Fontenele SMDA, Andrade SCDA, d'Alva CB. Treatment of postmenopausal osteoporosis: a literature-based algorithm for use in the public health care system. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:254-263. [PMID: 28535898 DOI: 10.1016/j.rbre.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/05/2016] [Indexed: 06/07/2023] Open
Abstract
Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies. However, despite the association between these effects and bisphosphonates, this risk should be analyzed in the context of osteoporosis treatment, alongside the benefit of preventing osteoporotic fractures and their clinical consequences. Therefore, we consider it plausible to discuss the restriction to the use of bisphosphonates, possible indications for prolonged treatment and alternative therapies following the suspension of this drug class for patients with persistent high risk of fracture after initial treatment, especially considering the problems of public health funding in Brazil and the shortage of drugs provided by the government. Thus, to standardize the treatment of osteoporosis in the public health care system, we aim to develop a proposal for a scientifically-based pharmacological treatment for postmenopausal osteoporosis, establishing criteria for indication and allowing the rational use of each pharmacological agent. We discuss the duration of the initial bisphosphonate treatment, the therapeutic options for refractory patients and potential indications of other classes of drugs as first-choice treatment in the sphere of public health, in which assessing risk and cost effectiveness is a priority.
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Affiliation(s)
- Ellen Luz Pereira Caires
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Endocrinologia e Diabetes, Fortaleza, CE, Brazil
| | - Mailze Campos Bezerra
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Reumatologia, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Ana Flávia Torquato de Araújo Junqueira
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Endocrinologia e Diabetes, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Sheila Márcia de Araújo Fontenele
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Reumatologia, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Silvana Cristina de Albuquerque Andrade
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Nefrologia e Transplante Renal, Fortaleza, CE, Brazil
| | - Catarina Brasil d'Alva
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Endocrinologia e Diabetes, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil.
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25
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Sowa PM, Downes MJ, Gordon LG. Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors. J Bone Miner Metab 2017; 35:199-208. [PMID: 26969395 DOI: 10.1007/s00774-016-0742-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
Postmenopausal women with breast cancer on aromatase inhibitor (AI) treatment are at increased risk of bone mineral density loss, which may lead to minimal trauma fractures. We examined the cost-effectiveness of dual energy X-ray absorptiometry (DXA) with antiresorptive (AR) therapy compared with fracture risk assessment, lifestyle advice, and vitamin supplementation. We used a hypothetical Markov cohort model of lifetime duration for 60-year-old women with early stage breast cancer receiving AIs. The data to inform the model came from medical literature, epidemiological reports, and costing data sets. Two eligibility scenarios for AR therapy were considered: (A) osteoporosis and (B) osteopenia or osteoporosis. The main outcomes were incremental cost per quality-adjusted life years gained and cumulative fractures per 1000 women, calculated relative to the comparator. Key aspects of the model were explored in sensitivity analyses. Due to relatively low effectiveness gains, the outcomes were primarily driven by the costs. The incremental cost per quality-adjusted life year gained was A$47,556 and A$253,000 for scenarios A and B, respectively. The numbers of fractures avoided were 56 and 77 per 1000 women, respectively. The results were most sensitive to the initial probability of osteoporosis, baseline risk of fracture, and cohort starting age. Compared with risk assessment and lifestyle advice only, a DXA scan followed by an AR treatment is potentially cost-effective for women aged 60 and over undergoing AI therapy for early breast cancer. However, the number of fractures averted through this intervention is small.
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MESH Headings
- Absorptiometry, Photon/economics
- Aromatase Inhibitors/therapeutic use
- Australia
- Bone Density/drug effects
- Bone Density Conservation Agents/economics
- Bone Density Conservation Agents/therapeutic use
- Bone Diseases, Metabolic/drug therapy
- Bone Diseases, Metabolic/economics
- Bone Diseases, Metabolic/prevention & control
- Breast Neoplasms/drug therapy
- Cost-Benefit Analysis
- Female
- Fractures, Bone/economics
- Fractures, Bone/epidemiology
- Fractures, Bone/prevention & control
- Health Care Costs
- Humans
- Markov Chains
- Middle Aged
- Osteoporosis, Postmenopausal/drug therapy
- Osteoporosis, Postmenopausal/economics
- Osteoporosis, Postmenopausal/prevention & control
- Quality-Adjusted Life Years
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Affiliation(s)
- P Marcin Sowa
- Research School of Population Health, Australian National University, Acton, ACT, 2601, Australia.
| | - Martin J Downes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia
| | - Louisa G Gordon
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia
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Belhassen M, Confavreux CB, Cortet B, Lamezec L, Ginoux M, Van Ganse E. Anti-osteoporotic treatments in France: initiation, persistence and switches over 6 years of follow-up. Osteoporos Int 2017; 28:853-862. [PMID: 27766368 DOI: 10.1007/s00198-016-3789-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/22/2016] [Indexed: 01/18/2023]
Abstract
UNLABELLED Limited information is available on anti-osteoporotic treatment initiation patterns in France. In 2006-2013, the most frequently prescribed first-line treatment class for osteoporosis was represented by bisphosphonates (alendronic acid and risedronic acid), followed by strontium ranelate. Persistence with anti-osteoporotic treatment was low, with high proportions of treatment discontinuations and switches. INTRODUCTION This epidemiological, longitudinal study described first-line treatment initiation, persistence, switches to second-line treatment, and medical care consumption in osteoporotic patients in France during the 2007-2013 period. METHODS Patients aged ≥50 years, who were recorded in a French claims database and did not die during the observation period, were included if they met ≥1 inclusion criteria for osteoporosis in 2007 (≥1 reimbursement for anti-osteoporotic treatment, hospitalisation for osteoporotic fracture (spine, hip, femur, forearm bones, humerus, wrist), or ≥1 reimbursement for long-term osteoporosis-associated status). We collected data on consumption of anti-osteoporotic treatment (alendronic acid, ibandronic acid, risedronic acid, zoledronic acid, raloxifene, strontium ranelate, teriparatide) and of osteoporosis-related medical care after the date of first reimbursement for anti-osteoporotic treatment. RESULTS We obtained 2219 patients with a 6-year follow-up and 1387 who initiated an anti-osteoporotic treatment in 2007 and who can be selected for the treatment regimen analysis. The most frequently used first-line treatments were alendronic acid (32.7 %), risedronic acid (22.4 %), strontium ranelate (19.3 %), ibandronic acid (13.1 %) and raloxifene (12.2 %). Among patients who received these treatments, the highest persistence after 6 years was observed for raloxifene (37.3 %), alendronic acid (35.1 %) and risedronic acid (32.3 %). Treatment discontinuations were reported for 35.5 % (raloxifene) to 53.4 % (strontium ranelate) and treatment switches for 27.4 % (alendronic acid) to 56.6 % (ibandronic acid) of these patients. CONCLUSIONS This study showed that persistence with anti-osteoporotic treatment was relatively low in France, with high proportions of treatment discontinuations and switches, and that patients with osteoporosis were insufficiently monitored by bone specialists.
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Affiliation(s)
- M Belhassen
- Merck Sharp and Dohme, Paris, France.
- PELyon, PharmacoEpidemiologie Lyon, Faculté d'Odontologie, 11 rue Guillaume Paradin, F-69372, Lyon, Cedex 08, France.
- HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France.
| | - C B Confavreux
- INSERM UMR 1033-University of Lyon, Rheumatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - B Cortet
- Department of Rheumatology and EA 4490, Lille University Hospital, Lille, France
| | - L Lamezec
- Merck Sharp and Dohme, Paris, France
| | - M Ginoux
- PELyon, PharmacoEpidemiologie Lyon, Faculté d'Odontologie, 11 rue Guillaume Paradin, F-69372, Lyon, Cedex 08, France
- HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - E Van Ganse
- PELyon, PharmacoEpidemiologie Lyon, Faculté d'Odontologie, 11 rue Guillaume Paradin, F-69372, Lyon, Cedex 08, France
- HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
- Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France
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Goodwin JS, Zhou J, Kuo YF, Baillargeon J. Risk of Jaw Osteonecrosis After Intravenous Bisphosphonates in Cancer Patients and Patients Without Cancer. Mayo Clin Proc 2017; 92:106-113. [PMID: 27876314 PMCID: PMC5219844 DOI: 10.1016/j.mayocp.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/08/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the risk of jaw osteonecrosis after intravenous (IV) bisphosphonate administered to patients with cancer vs patients without cancer. PATIENTS AND METHODS We conducted a retrospective cohort study of a 5% national sample of Medicare patients administered IV bisphosphonate from January 1, 2008, through December 31, 2013, for cancer vs noncancer indications. Probable jaw osteonecrosis was estimated with an algorithm including diagnoses, surgical procedures, and imaging studies. A non-IV bisphosphonate comparison group included patients prescribed an oral bisphosphonate for 30 days or less. RESULTS During follow-up, 40 (0.42%) out of 9482 patients with cancer developed probable jaw osteonecrosis compared with 8 (0.05%) out of 16,046 patients without cancer. In a Cox multivariable survival analysis controlling for patient characteristics and number of IV zoledronic infusions, patients without cancer had a hazard ratio of 0.17 (95% CI, 0.06-0.46) for developing jaw osteonecrosis compared with those with cancer. The lower rate of jaw osteonecrosis in patients without cancer was also confirmed in a number of sensitivity analyses. CONCLUSION The low rate of jaw osteonecrosis in patients with osteoporosis who receive IV bisphosphonate should be weighed against the benefit of those agents in preventing hip and other fractures.
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Affiliation(s)
- James S Goodwin
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas.
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas; Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Jacques Baillargeon
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas
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Chan DC, Chang CHC, Lim LC, Brnabic AJM, Tsauo JY, Burge R, Hsiao FY, Jin L, Gürbüz S, Yang RS. Association between teriparatide treatment persistence and adherence, and fracture incidence in Taiwan: analysis using the National Health Insurance Research Database. Osteoporos Int 2016; 27:2855-2865. [PMID: 27172935 PMCID: PMC4981624 DOI: 10.1007/s00198-016-3611-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Medication persistence and adherence are critical for osteoporosis outcomes. Using the Taiwan National Health Insurance Research Database, we found that persistence and adherence to teriparatide were low in Taiwanese patients with osteoporosis and that greater persistence and adherence were associated with a lower incidence of hip and other nonvertebral fractures. INTRODUCTION The purpose of this study was to determine the persistence and adherence to teriparatide treatment in Taiwanese patients with osteoporosis, and to examine the association between persistence and adherence to teriparatide with fracture risks. METHODS Medical and pharmacy claims for 4,692 patients with vertebral or hip fractures and teriparatide prescriptions between 2005 and 2008 were identified (Taiwan National Health Insurance Research Database). Persistence was the time from the start of treatment to the first 90-day gap between two teriparatide prescriptions. Adherence was the number of teriparatide pens (each pen is used over 1 month) prescribed over 24 months. Association of persistence and adherence to teriparatide with fracture incidence was assessed using adjusted Cox proportional hazards models. RESULTS The proportion of patients persisting with teriparatide for >6 months and >12 months was 44.6 and 24.9 %, respectively. Over 24 months, 53.6 % of patients were adherent for >6 months and 33.9 % were adherent for >12 months. Patients persisting for >12 months had a significantly lower incidence of hip (adjusted hazard ratio [HR], 0.61 [95 % confidence interval (CI), 0.40-0.93], P = 0.0229) and nonvertebral fracture (HR, 0.79 [95 % CI, 0.63-0.99], P = 0.0462) compared with those who persisted for ≤12 months. Patients adherent for >12 months had a lower incidence of hip (HR, 0.66 [95 % CI, 0.46-0.96], P = 0.0286) and nonvertebral fracture (HR, 0.81 [95 % CI, 0.66-0.99], P = 0.0377) compared with those adherent for ≤12 months. CONCLUSIONS Persistence and adherence to teriparatide over 24 months were low in Taiwanese patients with osteoporosis; greater adherence and persistence were associated with a lower incidence of nonvertebral fractures.
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Affiliation(s)
- D-C Chan
- Superintendent Office, Chu-Tung Branch, National Taiwan University Hospital, Hsinchu County, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - L-C Lim
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopaedics, National Taiwan University Hospital, No. 7. Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - A J M Brnabic
- Real World Analytics, Eli Lilly Australia Pty Ltd, Sydney, Australia
| | - J-Y Tsauo
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - R Burge
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - F-Y Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - L Jin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - S Gürbüz
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R-S Yang
- Department of Orthopaedics, National Taiwan University Hospital, No. 7. Chung-Shan S. Rd., Taipei, 100, Taiwan.
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Langdahl BL, Ljunggren Ö, Benhamou CL, Marin F, Kapetanos G, Kocjan T, Lespessailles E, Napoli N, Nikolic T, Petto H, Moll T, Lindh E. Fracture Rate, Quality of Life and Back Pain in Patients with Osteoporosis Treated with Teriparatide: 24-Month Results from the Extended Forsteo Observational Study (ExFOS). Calcif Tissue Int 2016; 99:259-71. [PMID: 27137783 PMCID: PMC4960288 DOI: 10.1007/s00223-016-0143-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
We describe the pre-planned interim analysis of fracture outcomes, health-related quality of life (HRQoL) and back pain in patients with severe osteoporosis treated with teriparatide for up to 24 months in the Extended Forsteo (Forsteo(®) is a registered trade name of Eli Lilly and Company) Observational Study (ExFOS), a prospective, multinational, observational study. Data on incident clinical fractures, HRQoL (EQ-5D questionnaire) and back pain [100 mm visual analogue scale (VAS)] were collected. The number of patients with fractures was summarised in 6-month intervals and fracture rate over each 6-month period was assessed using logistic regression for repeated measures. Changes from baseline in EQ-5D and back pain VAS were analysed using mixed models for repeated measures. Of 1454 patients in the active treatment cohort, 90.6 % were female and 14.4 % were taking glucocorticoids. During teriparatide treatment (median duration 23.7 months), 103 patients (7.1 %) sustained a total of 122 incident clinical fractures (21 % vertebral, 79 % non-vertebral). A 49 % decrease in the odds of fractures and a 75 % decrease in the odds of clinical vertebral fractures were observed in the >18- to 24-month period versus the first 6-month period (both p < 0.05). EQ-5D scores and back pain VAS scores were significantly improved from baseline at each post-baseline observation during teriparatide treatment. In conclusion, patients with severe osteoporosis showed a significant reduction in the incident fracture rate during 24 months of teriparatide treatment in routine clinical practice, accompanied by a significant improvement in HRQoL and reduction in back pain. Results should be interpreted in the context of the non-controlled design of this observational study.
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Affiliation(s)
- Bente L Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus, Denmark.
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Eric Lespessailles
- Orléans Hospital, Orléans, France
- EA-4708-I3MTO, University of Orléans, Orléans, France
| | | | | | | | - Thomas Moll
- Eli Lilly and Company, Windlesham, Surrey, UK
| | - Erik Lindh
- Eli Lilly and Company, Windlesham, Surrey, UK
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Khosla S, Shane E. A Crisis in the Treatment of Osteoporosis. J Bone Miner Res 2016; 31:1485-7. [PMID: 27335158 DOI: 10.1002/jbmr.2888] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Sundeep Khosla
- Robert and Arlene Kogod Center on Aging and Endocrine Research Unit, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
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Chodick G, Moser SS, Goldshtein I. Non-adherence with bisphosphonates among patients with osteoporosis: impact on fracture risk and healthcare cost. Expert Rev Pharmacoecon Outcomes Res 2016; 16:359-70. [PMID: 27015247 DOI: 10.1586/14737167.2016.1171145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Osteoporosis-related fractures at the spine and hip have a substantial impact on mortality, morbidity, and quality of life in older adults worldwide. Adherence to bisphosphonates is essential for effective treatment and fracture prevention. Nevertheless, numerous studies from various populations and study designs clearly indicated that adherence and persistence are poor with more than 50% of patients discontinuing therapy within one year. This is primarily explained by mild adverse effects, dosing regimens, and costs. Studies have also shown that good adherence is associated with reduced osteoporosis-related and non-related healthcare costs as soon as 2 years from therapy initiation. Nonetheless, we found only little improvement in adherence rates over the years. In light of the importance of medication adherence and the limited success of previous programs, other than reducing dosing frequency, new directions should be explored to engage patients and care givers in order to improve adherence and prevent fractures.
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Affiliation(s)
- Gabriel Chodick
- a Medical division , Maccabi Healthcare Services , Tel Aviv , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | | | - Inbal Goldshtein
- a Medical division , Maccabi Healthcare Services , Tel Aviv , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Abstract
Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture.
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Sharman Moser S, Yu J, Goldshtein I, Ish-Shalom S, Rouach V, Shalev V, Modi A, Chodick G. Cost and Consequences of Nonadherence With Oral Bisphosphonate Therapy: Findings From a Real-World Data Analysis. Ann Pharmacother 2016; 50:262-9. [PMID: 26783359 DOI: 10.1177/1060028015626935] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adherence to osteoporosis treatment remains poor despite available treatments and physician and patient education. This study aims to determine the effect of low adherence in real-world data. OBJECTIVE To examine the association between adherence with oral bisphosphonate therapy and fracture risk as well as health care resource utilization. METHODS Women included in this retrospective analysis were 55 years or older and had started oral bisphosphonate therapy between 2005 and 2011 in a large not-for-profit health care center in Israel. Adherence to therapy was measured by the medication possession ratio (MPR) during the first year from therapy initiation. Patients with MPR lower than 70% were considered nonadherent. Study outcomes were osteoporotic fracture events and health care utilization (including physician visits and hospitalizations) during the second year from therapy initiation. RESULTS Among the 17 770 women included in the analysis (mean age = 66.5 years; SD = ±8.3 years), 48.9% were nonadherent to therapy during the first year of treatment. Osteoporotic fracture risks during the second year among adherent and nonadherent patients were 2.1% and 2.5%, respectively (P = 0.1). When analysis was limited to patients 75 years or older, nonadherence with bisphosphonates was associated with an adjusted odds ratio of 1.49 (95% CI = 1.08-2.04) for osteoporotic fractures compared with adherent patients. Nonadherent patients had 13.4% higher medical costs than their adherent counterparts among patients 75 years and older (P = 0.002). CONCLUSIONS In patients 75 years and older, nonadherence with oral bisphosphonates can be associated with significantly greater short-term risk of osteoporotic fractures and higher utilization of health care services.
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Affiliation(s)
| | | | | | | | - Vanessa Rouach
- Maccabi Healthcare Services, Tel Aviv, Israel Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - Varda Shalev
- Maccabi Healthcare Services, Tel Aviv, Israel Tel Aviv University, Israel
| | | | - Gabriel Chodick
- Maccabi Healthcare Services, Tel Aviv, Israel Tel Aviv University, Israel
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Ong KL. Can't Catch a Break: Try Using Anti-Osteoporotic Therapy: Commentary on an article by Harpreet S. Bawa, MD, et al.: "Anti-Osteoporotic Therapy After Fragility Fracture Lowers Rate of Subsequent Fracture: Analysis of a Large Population Sample". J Bone Joint Surg Am 2015; 97:e65. [PMID: 26446972 DOI: 10.2106/jbjs.o.00692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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