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Hayes KN, Cadarette SM, Burden AM. Methodological guidance for the use of real-world data to measure exposure and utilization patterns of osteoporosis medications. Bone Rep 2024; 20:101730. [PMID: 38145014 PMCID: PMC10733639 DOI: 10.1016/j.bonr.2023.101730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/26/2023] Open
Abstract
Observational studies of osteoporosis medications can provide critical real-world evidence (RWE) that fills knowledge gaps left by clinical trials. However, careful consideration of study design is needed to yield reliable estimates of association. In particular, obtaining valid measurements of exposure to osteoporosis medications from real-world data (RWD) sources is complicated due to different medication classes, formulations, and routes of administration, each with different pharmacology. Extended half-lives of bisphosphonates and extended dosing of denosumab and zoledronic acid require particular attention. In addition, prescribing patterns and medication taking behavior often result in gaps in therapy, switching, and concomitant use of osteoporosis therapies. In this review, we present important considerations and provide specialized guidance for measuring osteoporosis drug exposures in RWD. First, we compare different sources of RWD used for osteoporosis drug studies and provide guidance on identifying osteoporosis medication use in these data sources. Next, we provide an overview of osteoporosis pharmacology and how it can influence decisions on exposure measurement within RWD. Finally, we present considerations for the measurement of osteoporosis medication exposure, adherence, switching, long-term exposures, and drug holidays using RWD. Ultimately, a thorough understanding of the differences in RWD sources and the pharmacology of osteoporosis medications is essential to obtain valid estimates of the relationship between osteoporosis medications and outcomes, such as fractures, but also to improve the critical appraisal of published studies.
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Affiliation(s)
- Kaleen N. Hayes
- Brown University School of Public Health, Providence, RI, USA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Suzanne M. Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Andrea M. Burden
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
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Konstantelos N, Rzepka AM, Burden AM, Cheung AM, Kim S, Grootendorst P, Cadarette SM. Fracture definitions in observational osteoporosis drug effects studies that leverage healthcare administrative (claims) data: a scoping review. Osteoporos Int 2022; 33:1837-1844. [PMID: 35578134 PMCID: PMC9463274 DOI: 10.1007/s00198-022-06395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
UNLABELLED Healthcare administrative (claims) data are commonly utilized to estimate drug effects. We identified considerable heterogeneity in fracture outcome definitions in a scoping review of 57 studies that estimated osteoporosis drug effects on fracture risk. Better understanding of the impact of different fracture definitions on study results is needed. PURPOSE Healthcare administrative (claims) data are frequently used to estimate the real-world effects of drugs. Fracture incidence is a common outcome of osteoporosis drug studies. We aimed to describe how fractures are defined in studies that use claims data. METHODS We searched MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and gray literature for studies published in English between 2000 and 2020 that estimated fracture effectiveness (hip, humerus, radius/ulna, vertebra) or safety (atypical fracture of the femur, AFF) of osteoporosis drugs using claims data in Canada and the USA. Literature searches, screening and data abstraction were completed independently by two reviewers. RESULTS We identified 57 eligible studies (52 effectiveness, 3 safety, 2 both). Hip fracture was the most common fracture site studied (93%), followed by humerus (66%), radius/ulna (59%), vertebra (61%), and AFF (9%). Half (n = 29) of the studies did not indicate specific data sources, codes, or cite a validation paper. Of the papers with sufficient detail, heterogeneity in fracture definitions was common. The most common definition within each fracture site was used by less than half of the studies that examined effectiveness (12 definitions in 29 hip fracture papers, 8 definitions in 17 humerus papers, 8 definitions in 13 radius/ulna papers, 9 definitions in 15 vertebra papers), and 3 definitions among 4 AFF papers. CONCLUSION There is ambiguity and heterogeneity in fracture outcome definitions in studies that leverage claims data. Better transparency in outcome reporting is needed. Future exploration of how fracture definitions impact study results is warranted.
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Affiliation(s)
- N Konstantelos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
| | - A M Rzepka
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - A M Burden
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- ETH Zurich, Zurich, Switzerland
| | - A M Cheung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - S Kim
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - P Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Toronto, Canada
| | - S M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Toronto, Canada
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
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Hayes KN, Brown KA, Cheung AM, Kim SA, Juurlink DN, Cadarette SM. Comparative Fracture Risk During Osteoporosis Drug Holidays After Long-Term Risedronate Versus Alendronate Therapy : A Propensity Score-Matched Cohort Study. Ann Intern Med 2022; 175:335-343. [PMID: 35007149 DOI: 10.7326/m21-2512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An osteoporosis drug holiday is recommended for most patients after 3 to 5 years of therapy. Risedronate has a shorter half-life than alendronate, and thus the residual length of fracture protection may be shorter. OBJECTIVE To examine the comparative risks of drug holidays after long-term (≥3 years) risedronate versus alendronate therapy. DESIGN Population-based, matched, cohort study. SETTING Province-wide health care administrative databases providing comprehensive coverage to Ontario residents aged 65 years or older between November 2000 and March 2020. PATIENTS Persons aged 66 years or older who had long-term risedronate therapy and a drug holiday were matched 1:1 on propensity score to those who had long-term alendronate therapy and a drug holiday. MEASUREMENTS The primary outcome was hip fracture within 3 years after a 120-day ascertainment period. Secondary analyses included shorter follow-up and sex-specific estimates. Cox proportional hazards models were used to estimate hazard ratios (HRs) for fracture risk between groups. RESULTS A total of 25 077 propensity score-matched pairs were eligible (mean age, 81 years; 81% women). Hip fracture rates were higher among risedronate than alendronate drug holidays (12.4 and 10.6 events, respectively, per 1000 patient-years; HR, 1.18 [95% CI, 1.04 to 1.34]; 915 total hip fractures). The association was attenuated when any fracture was included as the outcome (HR, 1.07 [CI, 1.00 to 1.16]) and with shorter drug holidays (1 year: HR, 1.03 [CI, 0.85 to 1.24]; 2 years: HR, 1.14 [CI, 0.96 to 1.32]). LIMITATION Analyses were limited to health care administrative data (potential unmeasured confounding), and some secondary analyses contained few events. CONCLUSION Drug holidays after long-term therapy with risedronate were associated with a small increase in risk for hip fracture compared with alendronate drug holidays. Future research should examine how best to mitigate this risk. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Kaleen N Hayes
- Brown University School of Public Health, Providence, Rhode Island, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (K.N.H.)
| | - Kevin A Brown
- Dalla Lana School of Public Health, University of Toronto, ICES, and Public Health Ontario, Toronto, Ontario, Canada (K.A.B.)
| | - Angela M Cheung
- Dalla Lana School of Public Health and Department of Medicine, University of Toronto, and University Health Network, Toronto, Ontario, Canada (A.M.C.)
| | - Sandra A Kim
- Department of Medicine, University of Toronto, and Centre for Osteoporosis & Bone Health, Women's College Hospital, Toronto, Ontario, Canada (S.A.K.)
| | - David N Juurlink
- Dalla Lana School of Public Health, University of Toronto, ICES, and Sunnybrook Research Institute, Toronto, Ontario, Canada (D.N.J.)
| | - Suzanne M Cadarette
- Dalla Lana School of Public Health and Leslie Dan Faculty of Pharmacy at the University of Toronto and ICES, Toronto, Ontario, Canada, and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina (S.M.C.)
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Hayes KN, Ban JK, Athanasiadis G, Burden AM, Cadarette SM. Time trends in oral bisphosphonate initiation in Ontario, Canada over 20 years reflect drug policy and healthcare delivery changes. Osteoporos Int 2019; 30:2311-2319. [PMID: 31317249 DOI: 10.1007/s00198-019-05061-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/14/2019] [Indexed: 01/25/2023]
Abstract
UNLABELLED Characteristics of patients starting oral bisphosphonate therapy changed over time, reflecting trends in osteoporosis management (e.g., new drugs to market), and general healthcare delivery (e.g., benzodiazepine use declined, statin use increased). When designing studies that examine osteoporosis drug effects, potential time-related biases must be considered. INTRODUCTION To describe the type of oral bisphosphonate initiated and characteristics of patients starting oral bisphosphonate therapy over time. METHODS We identified community-dwelling older adults (ages ≥ 66 years) initiating oral bisphosphonate therapy from April 1996 to March 2016 (1996 to 2015 fiscal years) using healthcare administrative data in Ontario. Patients with conditions other than osteoporosis that may impact bisphosphonate prescribing were excluded. The bisphosphonate initiated and patient characteristics were summarized by fiscal year and stratified by sex. RESULTS We identified 560,817 eligible patients (81% women). Most patients initiated cyclical etidronate from 1996 until 2005, and then weekly regimens became dominant. In 2008, risedronate became the main oral bisphosphonate (46% risedronate, 43% alendronate, 11% etidronate); with its use increasing after availability of monthly and delayed-release risedronate formulations. In 2015, 71% of patients started risedronate, 28% started alendronate, and less than 2% started etidronate. Characteristics of patients changed over time, reflecting changes in osteoporosis management and general healthcare delivery. Over time, a larger proportion of men (9% to 28%) and patients with diabetes (women 10% to 17%, men 14% to 22%) initiated therapy; benzodiazepine (women 22% to 13%, men 20% to 10%) and estrogen-based hormone replacement therapy (12% to 15% of women 1996-2002 to 3% since 2008) decreased, while statin use increased (women 15% to 39%, men 14% to 52%). CONCLUSIONS The characteristics of patients starting oral bisphosphonate therapy have changed over time. Consideration must be given to these time trends when designing studies that examine osteoporosis drug effects.
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Affiliation(s)
- K N Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - J K Ban
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - G Athanasiadis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - A M Burden
- Department of Chemistry and Applied Biosciences, ETH Zürich, Institute of Pharmaceutical Sciences, Zürich, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital and University of Zurich, Zurich, Switzerland
| | - S M Cadarette
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
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Reynolds AW, Liu G, Kocis PT, Skowronski JN, Leslie DL, Fox EJ. Comparison of Osteoporosis Pharmacotherapy Fracture Rates: Analysis of a MarketScan ® Claims Database Cohort. Int J Endocrinol Metab 2018; 16:e12104. [PMID: 30464768 PMCID: PMC6216103 DOI: 10.5812/ijem.12104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications. OBJECTIVES To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database. METHODS The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. Logistic regression was used to account for and quantify the contribution of risk factors, and to make direct comparisons between different osteoporosis medications. RESULTS A total of 51649 patients were included in the cohort, with an average age of 56 years. The overall incidence rate of fracture was 1.55 per 100 person - years of treatment. Orally administered medications had the lowest fracture rates, led by raloxifene and alendronate (1.24 and 1.54 respectively), while parenterally administered medications including teriparatide and zolerdonic acid had the highest rates (3.90 and 1.98 respectively). No statistically significant differences found between oral or parenterally administered bisphosphonate medications. CONCLUSIONS While patients taking orally administered drugs including bisphosphonates had less frequent incident fracture no statistically significant differences were found between most drugs in head - to - head comparisons, even considering the route of administration of bisphosphonates. These findings support previous evidence that minimal differences in efficacy exist between different osteoporosis medications. This is the first study using a large database to compare all currently available osteoporosis treatments and will hopefully be augmented by further study to provide more evidence to make clinical decisions on osteoporosis medication use.
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Affiliation(s)
- Alan W Reynolds
- Orthopaedics and Rehabilitation, Pennsylvania State College of Medicine, Hershey, U.S.A
| | - Guodong Liu
- Public Health Sciences, Pennsylvania State University, Hershey, U.S.A
| | - Paul T Kocis
- Pharmacy Disease Management, Pennsylvania State Hershey Medical Center, Hershey, U.S.A
| | - Jenna N Skowronski
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, U.S.A
| | - Douglas L Leslie
- Public Health Sciences, Pennsylvania State University, Hershey, U.S.A
| | - Edward J Fox
- Orthopaedics and Rehabilitation, Pennsylvania State College of Medicine, Hershey, U.S.A
- Corresponding author: Edward J Fox, Orthopaedics and Rehabilitation, Pennsylvania State College of Medicine, Hershey, 30 Hope Drive, P. O. Box: 859, Hershey, PA, 17033, USA. Tel: +1-7175315638, Fax: +1-7175310498, E-mail:
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Tremblay É, Perreault S, Dorais M. Persistence with denosumab and zoledronic acid among older women: a population-based cohort study. Arch Osteoporos 2016; 11:30. [PMID: 27679503 DOI: 10.1007/s11657-016-0282-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Persistence to denosumab or zoledronic acid was increased compared to oral bisphosphonates. INTRODUCTION Denosumab and zoledronic acid are alternative therapies to oral bisphosphonates. Few studies have assessed persistence of those agents. METHODS Incident users of denosumab and zoledronic acid were identified using healthcare databases of public drug insurance plan of Quebec province, Canada. Patients initiating therapy between October 1, 2008, and June 30, 2013, and aged 50 years and over were eligible. A persistence rate was assessed over a 2-year period. We assess the proportion of patients receiving the second, third, and fourth injections within a specific delay of predicted time of renewal of both agents. The predictors of non-persistence were analyzed using a Cox regression model only among women. RESULTS Among 12,689 incident users, 97.2 % were women. Kaplan-Meier analysis showed a slow decline of persistence after initiating zoledronic acid compared to denosumab therapy, dropping to 81.6 and 63.3 % after 1 and 2 years of follow-up using the permissive gaps of 56 days, in contrast to zoledronic acid, where persistence rate still stays at 74.8 % after 2 years of follow-up using the permissive gap of 112 days. The likelihood of non-persistence was significantly higher among new users of denosumab and zoledronic acid among older patients and year of initiation; but depression and diabetes are only predictors of non-persistence among the zoledronic group. Concomitant use of calcium and vitamin D supplements was at low level which may compromise the clinical efficacy. CONCLUSION The persistence rate to denosumab and zoledronic acid was higher to the published data of oral bisphosphonates. The second intention of treatment seems to target more severe patients which may more likely to be compliant.
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Affiliation(s)
- Éric Tremblay
- Institut d'excellence en santé et en services sociaux (INESSS), 2535, boul. Laurier, 5e, Québec, Québec, G1V 4M3, Canada.
| | - Sylvie Perreault
- Faculté de pharmacie de l'Université de Montréal, Montréal, Québec, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l'Île-Perrot, Québec, Canada
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Tadrous M, Mamdani MM, Juurlink DN, Krahn MD, Lévesque LE, Cadarette SM. Performance of the disease risk score in a cohort study with policy-induced selection bias. J Comp Eff Res 2015; 4:607-14. [PMID: 26529307 DOI: 10.2217/cer.15.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To examine the performance of the disease risk score (DRS) in a cohort study with evidence of policy-induced selection bias. METHODS We examined two cohorts of new users of bisphosphonates. Estimates for 1-year hip fracture rates between agents using DRS, exposure propensity scores and traditional multivariable analysis were compared. RESULTS The results for the cohort with no evidence of policy-induced selection bias showed little variation across analyses (-4.1-2.0%). Analysis of the cohort with evidence of policy-induced selection bias showed greater variation (-13.5-8.1%), with the greatest difference seen with DRS analyses. CONCLUSION Our findings suggest that caution may be warranted when using DRS methods in cohort studies with policy-induced selection bias, further research is needed.
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Affiliation(s)
- Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Muhammad M Mamdani
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - David N Juurlink
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5T, Canada
| | - Murray D Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada.,Toronto Health Economics & Technology Assessment (THETA) Collaborative, Toronto, ON, M5S 3M2, Canada
| | - Linda E Lévesque
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada.,Department of Public Health Sciences, Queen's University, 99 University Ave., Kingston, ON K7L 3N6, Canada
| | - Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada
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Citraro R, Gallelli L, Leo A, De Fazio P, Gallelli P, Russo E, De Sarro G. Effects of chronic sodium alendronate on depression and anxiety in a menopausal experimental model. Pharmacol Biochem Behav 2014; 129:65-71. [PMID: 25542587 DOI: 10.1016/j.pbb.2014.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/10/2014] [Accepted: 12/17/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE During menopause, lower levels of estrogen may induce bone resorption as well as anxiety and depression. Bisphosphonates represent the first choice in the treatment of osteoporosis and no data are available concerning their effects on comorbid behavior alterations. Therefore, in this study, we evaluated the effects of chronic alendronate (1 mg/kg/day) on depression and anxiety in an experimental animal model of menopause. METHODS Female Wistar rats were ovariectomized or sham operated at 6-7 months of age. Two weeks after surgery, rats were randomized into four treatment (24 consecutive weeks) groups: (1) vehicle-treated SHAM group, (2) alendronate-treated SHAM group, (3) vehicle-treated ovariectomized group, and (4) alendronate-treated ovariectomized group. After treatment, we evaluated both depressive- and anxiety-like behavior through forced swimming test (FST) and open-field test (OF). Finally, the inverted screen test was used to assess the incapacitating effects of ovariectomy in rats. RESULTS We documented a significant and time-related increase in immobility times and in anxiety-like behavior in rats with ovariectomy in comparison to control sham group. Alendronate at 3 months, but not at 6 months, significantly decreased both immobility time and anxiety levels, but it significantly increased motor performance. Using the Pearson's test, we documented a significant correlation between behavior and motor performance. CONCLUSION Despite the apparent effects of alendronate on animal behavior, in our experiments, such effects seem to be mediated by an increase in motor performance.
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Affiliation(s)
- Rita Citraro
- Science of Health Department, University of Catanzaro, Catanzaro 88100, Italy.
| | - Luca Gallelli
- Science of Health Department, University of Catanzaro, Catanzaro 88100, Italy.
| | - Antonio Leo
- Science of Health Department, University of Catanzaro, Catanzaro 88100, Italy.
| | - Pasquale De Fazio
- Science of Health Department, University of Catanzaro, Catanzaro 88100, Italy.
| | - Patrizia Gallelli
- Science of Health Department, University of Catanzaro, Catanzaro 88100, Italy.
| | - Emilio Russo
- Science of Health Department, University of Catanzaro, Catanzaro 88100, Italy.
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