DOCSLIB.ORG

Use of Anti-Osteoporosis Medication Dispensing by Patients with Hip Fracture: Could We Do Better?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Use of Anti-Osteoporosis Medication Dispensing by Patients with Hip Fracture: Could We Do Better? Osteoporosis International (2019) 30:1817–1825 https://doi.org/10.1007/s00198-019-05066-8 ORIGINAL ARTICLE Use of anti-osteoporosis medication dispensing by patients with hip fracture: could we do better? P. K. Kristensen1,2 & V. Ehrenstein1 & N. Shetty1,3 & A. B. Pedersen1 Received: 4 February 2019 /Accepted: 19 June 2019 /Published online: 29 June 2019 # International Osteoporosis Foundation and National Osteoporosis Foundation 2019 Abstract Summary Although Scandinavian countries have the highest incidence of hip fracture in the world, trends in anti-osteoporosis medication use have not been studied. We found less than one-third of Danish hip fracture patients had dispensing of anti- osteoporosis medication over a 10-year period using routinely collected data from population-based registries. Introduction To examine trend in dispensing of anti-osteoporosis medication before and after hip fracture surgery in Denmark over a 10-year period using routinely collected data from population-based registries. Methods From the Danish Multidisciplinary Hip Fracture Registry, we included 65,011 patients aged 65 years or older with an incident hip fracture in 2005–2015. We calculated, for each calendar year of hip fracture diagnosis, the prevalence of use of anti- osteoporosis medication (at least one dispensing of bisphosphonates, strontium ranelate, denosumab, selective estrogen receptor modulators, or teriparatide) in the year before and in the year following hip fracture diagnosis. Among those without a dispensing in the year before hip fracture, we computed 1-year cumulative incidence of use following hip fracture. We treated death as a competing risk and stratified the analysis on sex, age, and comorbidity. Results The prevalence of use before hip fracture varied between 7 and 12%, increasing slightly from 2005 to 2015. The cumulative incidence of use following hip fracture decreased from 16% in 2005 to 13% in 2010, whereupon it increased to 20%. A similar pattern was seen with each stratum of sex, age groups, and comorbidity. The overall prevalence of use after hip fracture was below 22% in all calendar years. Conclusions Less than one-third of hip fracture patients had dispensing of anti-osteoporosis medication up to 1 year after hip fracture. We observed only a slight increase in dispensing after hip fracture over the study period, irrespective of patient sex, age, and comorbidity at the time of hip fracture. Keywords Anti-osteoporosis medication . Bisphosphonates . Electronic supplementary material The online version of this article Hip fracture . Osteoporosis . Trend (https://doi.org/10.1007/s00198-019-05066-8) contains supplementary material, which is available to authorized users. * P. K. Kristensen Introduction [email protected]; [email protected] Osteoporosis affects over 200 million people worldwide [1], V. E hre ns te in [email protected] manifesting as nearly 9 million fractures, including fractures in the hip, spine, and distal forearm [2]. Sustaining a hip frac- N. Shetty ture more than triples the risk of a subsequent fracture, with [email protected] the highest risk concentrated within the first post-fracture year A. B. Pedersen [3–5]. Among patients with hip fracture, bisphosphonates are [email protected] an effective [6], but potentially underutilized, treatment for – 1 Department of Clinical Epidemiology, Aarhus University Hospital, secondary fracture prevention [7 13], with less than one- Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark third of these patients receiving treatment [14, 15]. The 2008 ’ 2 Department of Orthopaedic Surgery, Horsens Regional Hospital, Guidelines of the UK s National Institute for Health and Sundvej 30, DK-8700 Horsens, Denmark Clinical Excellence (NICE) recommend the use of anti- 3 Department of Bioscience, Applied Marine Ecology and Modelling, osteoporosis medication including bisphosphonates, raloxi- Frederiksborgvej 399, building B1.18, 4000 Roskilde, Denmark fene, teriparatide, or strontium ranelate for secondary fracture 1818 Osteoporos Int (2019) 30:1817–1825 prevention for all hip fracture patients [16]. In September National Health Services Prescription Database (outpatient 2018, the American Society for Bone and Mineral Research dispensing) [29]. recommended that people above 65 years who have a hip or spine fracture should be treated for osteoporosis [17]. Anti-osteoporosis medication dispensing Following publication of the NICE guidelines, studies inves- tigating the period up to 2013 have shown an increase in Anti-osteoporosis medication use was defined as at least initiation of treatment for secondary prevention after hip frac- one dispensing of an anti-osteoporosis medication ture, especially among women older than 75 years [18, 19]. (bisphosphonates including combinations, strontium Nevertheless, the overall treatment initiation rates remained ranelate, denosumab, selective estrogen receptor modu- unchanged at 34% in 1999–2013 [19]. Data from the lators, or teriparatide). We identified all anti- Scandinavian countries on recent trends in utilization of anti- osteoporosis medication dispensing in the year before osteoporosis medication for secondary fracture prevention can hip fracture and in the year after hip fracture. be accessed in national country statistics [20], but have not Switching between different types of anti-osteoporosis been summarized in peer review publications, despite their medications was not considered treatment termination. world’s highest incidence of hip fracture (average age- We classified patients as users of anti-osteoporosis med- standardized annual rate is 346/100,000 in Denmark com- ications in the 12 months before and in the 12 months pared with 123/100,000 in Spain) [21, 22]. The Danish after hip fracture, defined as at least one dispensing in Ministry for Health has estimated that up to 70% of the hip the respective time window (Fig. 1). To characterize fracture patients may benefit from secondary fracture preven- utilization, we classified pre-fracture use as either con- tion through anti-osteoporosis medication [23]. Furthermore, sistent use or intermittent use. Consistent use was de- pre-fracture comorbidity is associated with an additional mor- fined based on at least one dispensing within each 6- tality risk [24, 25]. Therefore, it is relevant to examine anti- month time window 12 months before hip fracture or osteoporosis treatment both overallandinthecontextof based on a dispensing in the first time 6-month window existing comorbidity. that continued into the second 6-month time window, We examined time trends in dispensing of anti- based on the number of defined daily doses plus a 90- osteoporosis medications before and after hip fracture in day grace period. Intermittent users was defined as at Denmark, overall, and stratified for sex, age, and comorbidity. least one dispensing in only one of the two 6-month time windows in the 12 months before hip fracture or Methods if the days in the first period did not continue in the second period (Fig. 1). With respect to post-fracture use of anti-osteoporosis medications, we defined continuous We conducted this population-based descriptive cohort study use as any use both 12 months before and 12 months in Denmark, a country with 5.7 million inhabitants, with uni- after hip fracture. Incident use was defined among non- versal access to medical care including partial reimbursement users in the 12 months before hip fracture as use in the of prescription drug costs. 12 months after hip fracture. Study population and data sources Patient characteristics Patients were identified in the Danish Multidisciplinary Hip Fracture Registry, which is a nationwide population-based We describe the study population in terms of sex, age at hip clinical quality database, established in 2003 [26]. The data- fracture date (categories 65–74 years, 75–84 years, and base records all patients at age 65 years or older with hip 85 years or older), body mass index (BMI) (underweight fracture and contains detailed data on patient characteristics (BMI < 18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), and in-hospital performance indicators. We included patients overweight (25–29.9 kg/m2), and obese (≥ 30 kg/m2)), and with an incident hip fracture who underwent surgery with fracture type according to the criteria used at the Danish arthroplasty or internal fixationfrom2005to2015(n = Multidisciplinary Hip Fracture Registry (undisplaced femoral 65,011). Patients with a diagnosis of hip fracture between neck, displaced femoral neck, unspecified femoral neck, 2003 and 2005 were excluded. We set the date of hip fracture pertrochanteric and subtrochanteric). We also summarized surgery to indicate the date of hip fracture. To the study pop- the 10-year pre-fracture hospital comorbidity history using ulation, we linked data from the Danish Civil Registration the Charlson Comorbidity Index (CCI) [28]: a score of 0 System (personal identifier for linkage, migrations, and vital (low), given to patients with no previous record of diseases status) [27], the Danish National Patient Registry (inpatient included in the CCI; a score of 1–2 (medium); and a score of 3 and outpatient hospital diagnoses) [28], and the Danish or more (high). Osteoporos Int (2019) 30:1817–1825 1819 All paents with hip fracture surgery 2005-2015 N=80,760 Paents with a previous hip fracture within 10 years N=15,749 All paents with incident hip fracture surgery 2005-2015 N=65,011 One year before hip fracture surgery One year a er hip fracture surgery Non-users Non-users a er Users before hip Users a er hip before hip hip fracture fracture surgery fracture surgery fracture surgery surgery N=6,131 N=10,276 N=58,880 N=54,735 Intermient N=1,030 Intermient Connuous N=5,516 Consistent N=5,101 Consistent Iniators N=4,760 Fig. 1 Flowchart for inclusion Statistical analysis used in this study. The study was approved by the Danish Data Protection Agency (Aarhus University record number 2016- We tabulated the patients’ characteristics overall and by the 051-000001). Data analyses were performed using SAS ver- use of anti-osteoporosis medication before and after hip frac- sion 9.4.
Load more

Recommended publications
  • 1.1. Bisphosphonates and Depressive Reactions
    1.1. Bisphosphonates and depressive reactions Introduction Bisphosphonates are the most commonly prescribed medications for the treatment of osteoporosis [1]. Alendronate (Fosamax ®) is indicated for the treatment and prevention of osteoporosis in postmenopausal women, treatment to increase bone mass in men with osteoporosis, treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater of prednisone and who have low bone mineral density, and treatment of Paget’s disease of bone in men and women [2]. Alendronate with colecalciferol (vitamin D3) (Fosavance ®) is indicated for the treatment of postmenopausal osteoporosis in patients at risk of vitamin D insufficiency [3]. Risedronate (Actonel ®) is used for the same indications as alendronate [4]. Risedronate with calcium (Actokit ®) is indicated for the treatment and prevention of osteoporosis in postmenopausal women [5]. Etidronate with calciumcarbonate (Didrokit ®) is indicated for the prevention and treatment of osteoporosis in post-menopausal women and the prevention of corticosteroid induced osteoporosis [6]. Ibandronate (Bonviva ®) is indicated for the treatment of osteoporosis in postmenopausal women at increased risk of fracture [7]. Pamidronate (Pamipro ®) is used intravenously for a different indication than most other bisphosphonates, namely tumour-induced hypercalcaemia, osteolytic lesions in patients with breast cancer related bone metastasis and multiple myeloma stage III [8]. Intravenous pamidronate is also used as APD infusion for the indication osteoporosis . Zoledronate (Zometa ®) is indicated for prevention of skeletal related events in patients with advanced malignancies involving bone or treatment of tumour-induced hypercalcaemia [9]. The most commonly used bisphosphonate in the Netherlands [10], alendronate (Fosamax ®), was granted marketing authorization in 1996 [2].
    [Show full text]
  • Guidelines on Management of Osteoporosis, April 2011 (Updated 04/2012, 06/2013, 09/2013, 04/2014, 09/2014 and 02/2015)
    Hertfordshire Guidelines on Management of Osteoporosis, April 2011 (updated 04/2012, 06/2013, 09/2013, 04/2014, 09/2014 and 02/2015) Guidelines on Management of Osteoporosis Introduction These guidelines take into account recommendations from the DH Guidance on Falls and Fractures (Jul 2009), NICE Technology appraisals for Primary and Secondary Prevention (updated January 2011) and interpreted locally, National Osteoporosis Guideline Group (NOGG) and local decisions on choice of drug treatment. The recommendations in the guideline should be used to aid management decisions but do not replace the need for clinical judgement in the care of individual patients in clinical practice. Diagnosis of osteoporosis The diagnosis of osteoporosis relies on the quantitative assessment of bone mineral density (BMD), usually by central dual energy X-ray absorptiometry (DXA). BMD at the femoral neck provides the reference site. It is defined as a value for BMD 2.5 SD or more below the young female adult mean (T-score less than or equal to –2.5 SD). Severe osteoporosis (established osteoporosis) describes osteoporosis in the presence of 1 or more fragility fracture. Diagnostic thresholds differ from intervention thresholds for several reasons. Firstly, the fracture risk varies at different ages, even with the same T-score. Other factors that determine intervention thresholds include the presence of clinical risk factors and the cost and benefits of treatment. Investigation of osteoporosis The range of tests will depend on the severity of the disease, age at presentation and the presence or absence of fractures. The aims of the clinical history, physical examination and clinical tests are to: • Exclude diseases that mimic osteoporosis (e.g.
    [Show full text]
  • Alendronate, Etidronate, Risedronate, Raloxifene, Strontium Ranelate And
    Issue date: October 2008 (amended January 2010 and January 2011) Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended) NICE technology appraisal guidance 161 (amended) NICE technology appraisal guidance 161 (amended) Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended) Ordering information You can download the following documents from www.nice.org.uk/guidance/TA161 • The NICE guidance (this document). • A quick reference guide – the recommendations. • ‘Understanding NICE guidance’ – a summary for patients and carers. • Details of all the evidence that was looked at and other background information. For printed copies of the quick reference guide or ‘Understanding NICE guidance’, phone NICE publications on 0845 003 7783 or email [email protected] and quote: • N1725 (quick reference guide) • N1726 (’Understanding NICE guidance’). This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity.
    [Show full text]
  • Botanicals in Postmenopausal Osteoporosis
    nutrients Review Botanicals in Postmenopausal Osteoporosis Wojciech Słupski, Paulina Jawie ´nand Beata Nowak * Department of Pharmacology, Wroclaw Medical University, ul. J. Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; [email protected] (W.S.); [email protected] (P.J.) * Correspondence: [email protected]; Tel.: +48-607-924-471 Abstract: Osteoporosis is a systemic bone disease characterized by reduced bone mass and the deterioration of bone microarchitecture leading to bone fragility and an increased risk of fractures. Conventional anti-osteoporotic pharmaceutics are effective in the treatment and prophylaxis of osteoporosis, however they are associated with various side effects that push many women into seeking botanicals as an alternative therapy. Traditional folk medicine is a rich source of bioactive compounds waiting for discovery and investigation that might be used in those patients, and therefore botanicals have recently received increasing attention. The aim of this review of literature is to present the comprehensive information about plant-derived compounds that might be used to maintain bone health in perimenopausal and postmenopausal females. Keywords: osteoporosis; menopause; botanicals; herbs 1. Introduction Women’s health and quality of life is modulated and affected strongly by hormone status. An oestrogen level that changes dramatically throughout life determines the Citation: Słupski, W.; Jawie´n,P.; development of women’s age-associated diseases. Age-associated hormonal imbalance Nowak, B. Botanicals in and oestrogen deficiency are involved in the pathogenesis of various diseases, e.g., obesity, Postmenopausal Osteoporosis. autoimmune disease and osteoporosis. Many female patients look for natural biological Nutrients 2021, 13, 1609. https:// products deeply rooted in folk medicine as an alternative to conventional pharmaceutics doi.org/10.3390/nu13051609 used as the prophylaxis of perimenopausal health disturbances.
    [Show full text]
  • Nutriceuticals: Over-The-Counter Products and Osteoporosis
    serum calcium levels are too low, and adequate calcium is not provided by the diet, calcium is taken from bone. Osteoporosis: Clinical Updates Long- term dietary calcium deficiency is a known risk Osteoporosis Clinical Updates is a publication of the National factor for osteo porosis. The recommended daily cal- Osteoporosis Foundation (NOF). Use and reproduction of this publication for educational purposes is permitted and cium intake from diet and supplements combined is encouraged without permission, with proper citation. This 1000 mg/day for people aged 19 to 50 and 1200 mg/ publication may not be used for commercial gain. NOF is a day for people older than 50. For all ages, the tolerable non-profit, 501(c)(3) educational organization. Suggested upper limit is 2500 mg calcium per day. citation: National Osteoporosis Foundation. Osteoporosis Clinical Updates. Issue Title. Washington, DC; Year. Adequate calcium intake is necessary for attaining peak bone mass in early life (until about age 30) and for Please direct all inquiries to: National Osteoporosis slowing the rate of bone loss in later life.3 Although Foundation 1150 17th Street NW Washington, DC 20037, calcium alone (or with vitamin D) has not been shown USA Phone: 1 (202) 223-2226 to prevent estrogen-related bone loss, multiple stud- Fax: 1 (202) 223-1726 www.nof.org ies have found calcium consumption between 650 mg Statement of Educational Purpose and over 1400 mg/day reduces bone loss and increases Osteoporosis Clinical Updates is published to improve lumbar spine BMD.4-6 osteoporosis patient care by providing clinicians with state-of-the-art information and pragmatic strategies on How to take calcium supplements: prevention, diagnosis, and treatment that they may apply in Take calcium supplements with food.
    [Show full text]
  • Strontium Ranelate Cochrane Reviews Does It Affect the Management of Postmenopausal Osteoporosis?
    CLINICAL PRACTICE Strontium ranelate Cochrane reviews Does it affect the management of postmenopausal osteoporosis? This series of articles facilitated by the Cochrane Musculoskeletal Group (CMSG) aims to place the findings of recent Tania Winzenberg Cochrane musculoskeletal reviews in a context immediately relevant to general practitioners. This article considers MBBS, FRACGP, whether the availability of strontium ranelate affects the management of postmenopausal osteoporosis. MMedSc(ClinEpi), PhD, is Research Fellow – General Practice, Menzies Research Institute, University of Osteoporosis is a costly condition1,2 and is the fifth the pharmacologically active component of the compound Tasmania. tania.winzenberg@ most common musculoskeletal problem managed in and has been shown to simultaneously decrease bone utas.edu.au general practice at 0.9 per 100 patient encounters.3 resorption and stimulate bone formation both in vitro and in Sandi Powell Secondary prevention of osteoporotic fracture is poorly animal models,6 although the exact mechanisms for these MBBS(Hons), is junior implemented4 despite the availability of efficacious actions are as yet unclear. Research Fellow, Menzies Research Institute, and senior 1 treatments. O’Donnell et al performed a systematic review to assess endocrinology registrar, Royal the efficacy and adverse effects of strontium compared Hobart Hospital, Tasmania Strontium ranelate, a pharmacological treatment for to either placebo or other treatments for postmenopausal Graeme Jones osteoporosis which is relatively new to Australia, has been osteoporosis. The review results are summarised in Table MBBS(Hons), FRACP, MMedSc, available on the Pharmaceutical Benefits Scheme (PBS) 1 and how these results might affect practice are shown MD, FAFPHM, is Head, by authority prescription since April 2007.5 Strontium is in Table 2.
    [Show full text]
  • Association Between Oral Anticoagulants and Osteoporosis
    Int. J. Med. Sci. 2020, Vol. 17 471 Ivyspring International Publisher International Journal of Medical Sciences 2020; 17(4): 471-479. doi: 10.7150/ijms.39523 Research Paper Association between oral anticoagulants and osteoporosis: Real-world data mining using a multi-methodological approach Satoshi Yokoyama1, Shoko Ieda2, Mirai Nagano1, Chihiro Nakagawa1, Makoto Iwase1, Kouichi Hosomi1, Mitsutaka Takada1 1. Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-osaka, Osaka 577-8502, Japan 2. Department of Pharmacy, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan Corresponding author: Satoshi Yokoyama, Ph. D., Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-osaka, Osaka, 577-8502, Japan. Telephone number: +81-6-6721-2332; Fax number: +81-6-6730-1394; E-mail address: [email protected] © The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions. Received: 2019.08.21; Accepted: 2020.01.08; Published: 2020.02.04 Abstract Introduction: Warfarin and direct oral anticoagulants (DOACs) have been widely used in antithrombotic therapy. Although warfarin use has been suspected to be associated with osteoporosis risk, several studies have shown otherwise. Conversely, a few reports have found an association between DOACs and osteoporosis. This study therefore clarifies the association between oral anticoagulants and osteoporosis by analyzing real-world data using different methodologies, algorithms, and databases. Methods: Real-world data from the US Food and Drug Administration Adverse Event Reporting System (FAERS; 2004–2016) and Japanese administrative claims database (2005–2017; JMDC Inc., Tokyo) were used.
    [Show full text]
  • Proton Pump Inhibitors and Fracture Risk: a Review of Current Evidence and Mechanisms Involved
    International Journal of Environmental Research and Public Health Review Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved Benjamin Ka Seng Thong , Soelaiman Ima-Nirwana and Kok-Yong Chin * Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia; [email protected] (B.K.S.T.), [email protected] (S.I.-N.) * Correspondence: [email protected]; Tel.: +60-3-9145-9573 Received: 5 March 2019; Accepted: 30 April 2019; Published: 5 May 2019 Abstract: The number of patients with gastroesophageal problems taking proton pump inhibitors (PPIs) is increasing. Several studies suggested a possible association between PPIs and fracture risk, especially hip fractures, but the relationship remains contentious. This review aimed to investigate the longitudinal studies published in the last five years on the relationship between PPIs and fracture risk. The mechanism underlying this relationship was also explored. Overall, PPIs were positively associated with elevated fracture risk in multiple studies (n = 14), although some studies reported no significant relationship (n = 4). Increased gastrin production and hypochlorhydria are the two main mechanisms that affect bone remodeling, mineral absorption, and muscle strength, contributing to increased fracture risk among PPI users. As a conclusion, there is a potential relationship between PPIs and fracture risks. Therefore, patients on long-term PPI treatment should pay attention to bone health status and consider prophylaxis to decrease fracture risk. Keywords: bone; compression; omeprazole; osteoporosis; pantoprazole 1. Introduction Proton pump inhibitors (PPIs) are lipophilic weak bases (pKa 4.0–5.0) consisting of two components: a substituted pyridine and a benzimidazole.
    [Show full text]
  • Prevention of Glucocorticoid-Induced Osteoporosis
    Supporting Evidence Document: Prevention of Glucocorticoid-induced Osteoporosis Background The recommendations for adult patients (> 18 years 2. The role of bisphosphonates old) found in the BCR GN protocols for reducing A bisphosphonate is recommended for the the risk of glucocorticoid- induced osteoporosis following patient groups taking prednisone are based on the 2010 and 2017 American > 2.5 mg/day for ≥ 3 months - as long as College of Rheumatology (ACR) guidelines for the no contraindications exist [conditional prevention and treatment of glucocorticoid-induced recommendation]: osteoporosis.1,2 1. Patients with a history of fragility fracture, or Many of the ACR recommendations are conditional, an established diagnosis of osteoporosis.1 meaning the desirable effects probably outweigh the 2. Postmenopausal women and men ≥ 50 years.2 undesirable ones. Therefore, these recommendations 3. Patients ≥ 30 years who require an initial apply to the majority of patients, but not all. As such, prednisone dose ≥ 30 mg/day, and who have conditional recommendations are preference-sensitive received a cumulative prednisone dose > 5 and always warrant a shared decision-making grams in the previous year (e.g. 30 mg daily approach. for 6 months).1 1. The role of calcium and vitamin D 3. The Fracture Risk Assessment Tool Calcium intake of 1000 to 1200 mg/day The latest guidelines from the United States and (supplement plus oral intake) and vitamin D United Kingdom have moved towards calculating supplementation of 600 to 800 units (supplement a 10-year
    [Show full text]
  • Pharmaco-Economic Study for the Prescribing of Prevention and Treatment of Osteoporosis
    Technical Report 2: An analysis of the utilisation and expenditure of medicines dispensed for the prophylaxis and treatment of osteoporosis Technical report to NCAOP/HSE/DOHC By National Centre for Pharmacoeconomics An analysis of the utilisation and expenditure of medicines dispensed for the prophylaxis and treatment of osteoporosis February 2007 National Centre for Pharmacoeconomics Executive Summary 1. The number of prescriptions for the treatment and prophylaxis of osteoporosis has increased from 143,261 to 415,656 on the GMS scheme and from 52,452 to 136,547 on the DP scheme over the time period 2002 to 2005. 2. In 2005 over 60,000 patients received medications for the prophylaxis and treatment of osteoporosis on the GMS scheme with an associated expenditure of €16,093,676. 3. Approximately 80% of all patients who were dispensed drugs for the management of osteoporosis were prescribed either Alendronate (Fosamax once weekly) or Risedronate (Actonel once weekly) respectively. 4. On the DP scheme, over 27,000 patients received medications for the prophylaxis and treatment of osteoporosis in 2005 with an associated expenditure of € 6,028,925. 5. The majority of patients treated with drugs affecting bone structure were over 70 years e.g. 12,224 between 70 and 74yrs and 25,518 over 75yrs. 6. In relation to changes in treatment it was identified from the study that approximately 8% of all patients who are initiated on one treatment for osteoporosis are later switched to another therapy. 7. There was a statistically significant difference between the use of any osteoporosis medication and duration of prednisolone (dose response, chi- square test, p<0.0001).
    [Show full text]
  • Recent Advances in the Pathogenesis and Treatment of Osteoporosis
    AGEING Clinical Medicine 2015 Vol 15, No 6: s92–s96 R e c e n t a d v a n c e s i n t h e p a t h o g e n e s i s a n d t r e a t m e n t of osteoporosis Authors: E l i z a b e t h M C u r t i s , A R e b e c c a J M o o n , B E l a i n e M D e n n i s o n , C N i c h o l a s C H a r v e y D a n d C y r u s C o o p e rE Over recent decades, the perception of osteoporosis has and propensity to fracture. Worldwide, there are nearly 9 changed from that of an inevitable consequence of ageing, to million osteoporotic fractures each year, and the US Surgeon that of a well characterised and treatable chronic non-commu- General's report of 2004, consistent with data from the UK, nicable disease, with major impacts on individuals, healthcare suggested that almost one in two women and one in five men systems and societies. Characterisation of its pathophysiol- will experience a fracture in their remaining lifetime from ABSTRACT ogy from the hierarchical structure of bone and the role of its the age of 50 years.1 The cost of osteoporotic fracture in the cell population, development of effective strategies for the UK approaches £3 billion annually and, across the EU, the identifi cation of those most appropriate for treatment, and estimated total economic cost of the approximately 3.5 million an increasing armamentarium of effi cacious pharmacologi- fragility fractures in 2010 was €37 billion.
    [Show full text]
  • Journal of Trace Elements in Medicine and Biology Strontium Stimulates
    Journal of Trace Elements in Medicine and Biology 55 (2019) 15–19 Contents lists available at ScienceDirect Journal of Trace Elements in Medicine and Biology journal homepage: www.elsevier.com/locate/jtemb Technical note Strontium stimulates alkaline phosphatase and bone morphogenetic protein- 4 expression in rat chondrocytes cultured in vitro T Jinfeng Zhanga,b,1, Xiaoyan Zhua,1, Yezi Konga, Yan Huanga, Xukun Danga, Linshan Meia, ⁎ ⁎ Baoyu Zhaoa, Qing Lina,b, , Jianguo Wanga, a College of Veterinary Medicine, Northwest A&F University, Yangling 712100, Shaanxi, China b State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining 810016, Qinghai, China ARTICLE INFO ABSTRACT Keywords: The trace element strontium has a significant impact on cartilage metabolism. However, the direct effects of Strontium strontium on alkaline phosphatase (ALP), a marker of bone growth, and bone morphogenetic protein-4 (BMP-4), Rat chondrocyte which plays a key role in the regulation of bone and cartilage development, are not entirely clear. In order to Expression understand the mechanisms involved in these processes, the chondrocytes were isolated from Wistar rat articular Alkaline phosphatase cartilage by enzymatic digestion and cultured under standard conditions. They were then treated with strontium Bone morphogenetic protein-4 at 0.5, 1.0, 2.0, 5.0, 20.0 and 100.0 μg/mL for 72 h. The mRNA abundance and protein expression levels of ALP and BMP-4 were measured using real-time polymerase chain reaction (real-time PCR) and Western blot analysis. The results showed that the levels of expression of ALP and BMP-4 in chondrocytes increased as the con- centration of strontium increased relative to the control group, and the difference became significant at 1.0 μg/ mL strontium (P < 0.05).
    [Show full text]