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Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate.

https://arctichealth.org/en/permalink/ahliterature140933
Source
Osteoporos Int. 2011 Jun;22(6):1725-35
Publication Type
Article
Date
Jun-2011
Author
D L Kendler
M R McClung
N. Freemantle
M. Lillestol
A H Moffett
J. Borenstein
S. Satram-Hoang
Y-C Yang
P. Kaur
D. Macarios
S. Siddhanti
Author Affiliation
University of British Columbia, 600-1285 West Broadway, V6H 3X8 Vancouver, BC, Canada. kendler@ca.inter.net
Source
Osteoporos Int. 2011 Jun;22(6):1725-35
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Alendronate - administration & dosage - adverse effects - therapeutic use
Antibodies, Monoclonal - administration & dosage - adverse effects - therapeutic use
Antibodies, Monoclonal, Humanized
Bone Density - drug effects
Bone Density Conservation Agents - administration & dosage - adverse effects - therapeutic use
British Columbia
Epidemiologic Methods
Female
Humans
Injections, Subcutaneous
Medication Adherence - statistics & numerical data
Middle Aged
Osteoporosis, Postmenopausal - drug therapy - physiopathology - psychology
Patient Preference - statistics & numerical data
Patient Satisfaction - statistics & numerical data
Treatment Outcome
Abstract
In this study, 250 women with osteoporosis were randomized to 12 months with subcutaneous denosumab 60 mg every 6 months or oral alendronate 70 mg once weekly, then crossed over to the other treatment. The primary endpoint, treatment adherence at 12 months, was 76.6% for alendronate and 87.3% for denosumab.
The purpose of this study is to evaluate treatment adherence with subcutaneous denosumab 60 mg every 6 months or oral alendronate 70 mg once weekly.
In this multicenter, randomized, open-label, 2-year, crossover study, 250 postmenopausal women with low bone mineral density received denosumab or alendronate for 12 months, then the other treatment for 12 months. The alendronate bottle had a medication event monitoring system cap to monitor administration dates. Definitions were as follows: compliance, receiving both denosumab doses 6 (± 1) months apart or 80-100% of alendronate doses; persistence, receiving both denosumab doses and completing the month 12 visit within the visit window or = 2 alendronate doses in the final month; adherence, achieving both compliance and persistence. This report includes data from the first 12 months.
The primary study endpoint, adherence in the first 12 months, was 76.6% (95/124) for alendronate and 87.3% (110/126) for denosumab. Risk ratios for denosumab compared with alendronate at 12 months were 0.58 (p = 0.043) for non-adherence, 0.48 (p = 0.014) for non-compliance, and 0.54 (p = 0.049) for non-persistence. Subject ratings for treatment necessity, preference, and satisfaction were significantly greater for denosumab and ratings for treatment bother were significantly greater for alendronate. Adverse events were reported by 64.1% of alendronate-treated subjects and 72.0% of denosumab-treated subjects (p = 0.403). The most common adverse events were arthralgia, back pain, pain in extremity, cough, and headache (each in
PubMed ID
20827547 View in PubMed
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Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database.

https://arctichealth.org/en/permalink/ahliterature183465
Source
Osteoporos Int. 2003 Oct;14(10):808-13
Publication Type
Article
Date
Oct-2003
Author
Alexandra Papaioannou
George Ioannidis
Jonathan D Adachi
Rolf J Sebaldt
Nicole Ferko
Mark Puglia
Jacques Brown
Alan Tenenhouse
Wojciech P Olszynski
Pauline Boulos
David A Hanley
Robert Josse
Timothy M Murray
Annie Petrie
Charlie H Goldsmith
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Osteoporos Int. 2003 Oct;14(10):808-13
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Aged
Alendronate - therapeutic use
Analysis of Variance
Canada
Diphosphonates - therapeutic use
Drug Therapy, Combination
Etidronic Acid - therapeutic use
Female
Follow-Up Studies
Hormone Replacement Therapy - psychology
Humans
Male
Middle Aged
Osteoporosis - drug therapy - psychology
Osteoporosis, Postmenopausal - drug therapy - psychology
Patient compliance
Proportional Hazards Models
Prospective Studies
Registries
Abstract
Therapies for osteoporosis must be taken for at least 1 year to be effective. The purpose of this study was to determine the difference in adherence to etidronate, alendronate and hormone replacement therapy in a group of patients seen at our tertiary care centres. The Canadian Database of Osteoporosis and Osteopenia (CANDOO), a prospective observational database designed to capture clinical data, was searched for patients who started therapy following entry into CANDOO. There were 1196 initiating etidronate, 477 alendronate and 294 hormone replacement therapy women and men aged (mean, SD) 65.8 (8.7) years in the study. A Cox proportional hazards regression model was used to assess differences between treatment groups in the time to discontinuation of therapy. Several potential covariates such as anthropometry, medications, illnesses, fractures and lifestyle factors were entered into the model. A forward selection technique was used to generate the final model. Hazard ratios and 95% confidence intervals (CI) were calculated. Adjusted results indicated that alendronate-treated patients were more likely to discontinue therapy as compared with etidronate-treated patients (1.404; 95% CI: 1.150, 1.714). After 1 year, 90.3% of patients were still taking etidronate compared with 77.6% for alendronate. No statistically significant differences were found between hormone replacement therapy and etidronate users (0.971; 95% CI: 0.862, 1.093) and hormone replacement therapy and alendronate users (0.824; 95% CI: 0.624, 1.088) after controlling for potential covariates. After 1 year, 80.1% of patients were still taking hormone replacement therapy, which decreased to 44.5% after 6 years. Increasing age and presence of incident non-vertebral fractures were found to be independent predictors of adherence. In conclusion, alendronate users were more likely to discontinue therapy than etidronate users over the follow-up period. Potential barriers to long-term patient adherence to osteoporosis therapies need to be evaluated.
PubMed ID
14523610 View in PubMed
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ALX 111: ALX1-11, parathyroid hormone (1-84) - NPS Allelix, PREOS, PTH, recombinant human parathyroid hormone, rhPTH (1-84).

https://arctichealth.org/en/permalink/ahliterature71301
Source
Drugs R D. 2003;4(4):231-5
Publication Type
Article
Date
2003
Author Affiliation
Adis International Ltd.
Source
Drugs R D. 2003;4(4):231-5
Date
2003
Language
English
Publication Type
Article
Keywords
Bone Density - drug effects
Clinical Trials, Phase II
Drug Industry
Female
Humans
Injections, Subcutaneous
Middle Aged
Multicenter Studies
Osteoporosis, Postmenopausal - drug therapy - prevention & control
Parathyroid Hormone - administration & dosage - adverse effects - therapeutic use
Randomized Controlled Trials
Recombinant Proteins - administration & dosage - adverse effects - therapeutic use
Treatment Outcome
Abstract
ALX 111 [parathyroid hormone (1-84) - NPS Allelix, recombinant human parathyroid hormone, rhPTH (1-84), PREOS] is a full-length, recombinant human parathyroid hormone. It has potential as an anti-osteoporotic agent, due to its properties as a bone formation stimulant.This profile has been selected from R&D Insight, a pharmaceutical intelligence database produced by Adis International Ltd. It has been recommended that ALX 111 should be given for 1 to 2 years and may be given in combination with an antiresorptive agent, such as estrogen or a bisphosphonate. In December 1999, Allelix Biopharmaceuticals merged with NPS Pharmaceuticals. This combined company is operating as NPS Pharmaceuticals in the US and as NPS Allelix in Canada. The merger has enabled a phase III study of ALX 111 to begin in the US, Europe and South America. NPS harmaceuticals has signed an agreement with Bio-Imaging Technologies, which will provide all image handling and analysis for this trial. Until 1994, Allelix Biopharmaceuticals and Glaxo in Canada were involved in a joint venture to investigate the efficacy of ALX 111 in osteoporosis. Allelix was subsequently, until September 1998, collaborating with Astra of Sweden in developing ALX 111. Astra had acquired exclusive worldwide rights to ALX 111 and was responsible for development of the agent. However, Astra returned all rights to ALX 111 to Allelix as a result of its merger with Zeneca to form AstraZeneca. In December 1999, Allelix Biopharmaceuticals merged with NPS Pharmaceuticals. This combined company is operating as NPS Pharmaceuticals in the US and as NPS Allelix in Canada. The merger has enabled a phase III study of ALX 111 to begin in the US, Europe and South America. The phase III trial of ALX 111 for the treatment of osteoporosis has completed patient enrolment, and phase II trials have been completed in Canada and the Netherlands. The 18-month, phase III, multicentre, placebo-controlled trial (Treatment of Osteoporosis with Parathyroid Hormone; TOP) has been designed to assess the bone-building and fracture-reducing potential of the drug, and over 2600 postmenopausal women with osteoporosis who have not received previous drug therapy for osteoporosis have been enrolled. Treatment will be completed in September 2003, but more than 75% of patients enrolled in the TOP study have chosen to enrol in an Open Label Extension Study (OLES), which allows for a total treatment period of up to 24 months. NPS Pharmaceuticals has signed an agreement with Bio-Imaging Technologies, which will provide all image handling and analysis for this trial. In September 2002, NPS Pharmaceuticals announced that it has met its patient enrolment target (n > 150) for its POWER (PTH for Osteoporotic Women on Estrogen Replacement) study; a 24-month phase III trial initiated in Europe in November 2001. In this trial, women with osteoporosis receive SC injections of ALX 111 or placebo, in combination with their existing hormone replacement therapies, to test the bone building potential of the drug. In addition to the POWER study, a clinical trial sponsored by the National Institutes of Health (NIH) is being conducted to evaluate the potential of ALX 111 to build bone in combination with another osteoporosis medication. The 'PaTH' study (PTH/alendronate) is designed to assess the effect of various combinations and sequential uses of ALX 111 and Merck's Fosamax, a drug for slowing the loss of bone due to osteoporosis. The PaTH study, initiated in May 2000 and scheduled to conclude in September 2003, involved 238 patients with postmenopausal osteoporosis. It is thought that alendronic acid and ALX 111, when administered in combination, may act in an additive manner to treat osteoporosis because they act in different ways; alendronic acid acts to inhibit resorption and ALX 111 speeds up bone formation and resorption, with a net increase in formation. Results of this study are still being analysed but preliminary results appear to be positive. The effect of ALX 111 on bone cell cultures underare still being analysed but preliminary results appear to be positive. The effect of ALX 111 on bone cell cultures under conditions of microgravity was tested in orbit on the Space Shuttle Columbia, which was launched on 16 January 2003 but did not survive re-entry. This study was one in a series of studies known as 'OSTEO' and had been prepared by researchers from NPS Pharmaceuticals using Millenium Biologix' OSTEO Mini-Lab System. Under space flight conditions, astronauts experience a loss in bone density at a rate up to ten times faster than that of earth-bound patients with osteoporosis, and it was hoped that this study would indicate the mechanism of action of ALX 111 at cellular and genetic levels. The results of these studies were represented by the samples of human bone cells, which were lost during the re-entry tragedy.
PubMed ID
12848587 View in PubMed
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An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials.

https://arctichealth.org/en/permalink/ahliterature80464
Source
Osteoporos Int. 2006 Dec;17(12):1781-93
Publication Type
Article
Date
Dec-2006
Author
Borgström F.
Jönsson B.
Ström O.
Kanis J A
Author Affiliation
Stockholm Health Economics, Vasagatan 38, 2nd floor, SE-111 21 Stockholm, Sweden. fredrik.b@healtheconomics.se
Source
Osteoporos Int. 2006 Dec;17(12):1781-93
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density Conservation Agents - economics - therapeutic use
Clinical Trials, Phase III
Cost-Benefit Analysis - economics
Female
Fractures, Bone - epidemiology - etiology
Health Care Costs
Humans
Markov Chains
Organometallic Compounds - economics - therapeutic use
Osteoporosis, Postmenopausal - drug therapy - economics - epidemiology
Quality of Life
Quality-Adjusted Life Years
Risk factors
Sweden - epidemiology
Thiophenes - economics - therapeutic use
Treatment Outcome
Abstract
INTRODUCTION: Strontium ranelate is a new therapy for the treatment and prevention of osteoporosis that has been shown in two phase III clinical trials (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and the Treatment Of Peripheral OSteoporosis Study [TROPOS] trials) to reduce the risk of osteoporotic fractures at the vertebral, non-vertebral and hip level in postmenopausal women. The aim of this study was to estimate the potential cost-effectiveness of strontium ranelate in the treatment of osteoporosis in postmenopausal Swedish patients. METHODS: A Markov cohort model was adapted to fit patients corresponding to the patients in the SOTI and TROPOS clinical trials. The model was populated with Swedish cost and epidemiological data. In the base case, the cost-effectiveness was estimated for 69-year old women with low bone mineral density (BMD) and prevalent vertebral fractures (SOTI) and for 77-year old women with low BMD (TROPOS). The cost-effectiveness analysis had a societal perspective. RESULTS: In the base case analysis, the cost per quality-adjusted life years (QALY) gained of strontium ranelate patients compared to no treatment patients was estimated at SEK 472,586 and SEK 259,643, including costs in added life years, based on the SOTI and the TROPOS trials, respectively. Excluding cost in added life years, the cost per QALY gained was estimated at SEK 336,420 (SOTI) and SEK 165,680 (TROPOS). In subgroup analyses, in patients 74 years and older with a T-score lower than -2.4 and patients older than 80 years of age, strontium ranelate was found to be cost saving compared to no treatment. CONCLUSIONS: The results in the base case analyses and the sensitivity analyses of this study indicate that, compared to no treatment, strontium ranelate is cost-effective in the treatment of postmenopausal women with low BMD.
PubMed ID
17009083 View in PubMed
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Are long-term bisphosphonate users a reality? Dose years for current bisphosphonate users assessed using the danish national prescription database.

https://arctichealth.org/en/permalink/ahliterature124526
Source
Osteoporos Int. 2013 Jan;24(1):369-72
Publication Type
Article
Date
Jan-2013
Author
B. Abrahamsen
Author Affiliation
Department of Medicine F, Gentofte Hospital, 2900, Hellerup, Denmark. b.abrahamsen@physician.dk
Source
Osteoporos Int. 2013 Jan;24(1):369-72
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Bone Density Conservation Agents - administration & dosage - therapeutic use
Databases, Factual
Denmark - epidemiology
Diphosphonates - administration & dosage - therapeutic use
Drug Administration Schedule
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Medication Adherence - statistics & numerical data
Middle Aged
Osteoporosis - drug therapy - epidemiology
Osteoporosis, Postmenopausal - drug therapy - epidemiology
Sex Distribution
Time Factors
Abstract
The prevalence of long-term bisphosphonate use may be low due to low refill compliance and gaps in treatment. An analysis of the prescription history of 58,674 bisphosphonate users in Denmark found that only 2.8 % had received ten dose years of treatment or above.
This study aims to describe the demographics of present bisphosphonate (BP) users, to determine the prevalence of long-term BP use, and to establish if long-term use (a 10-year history of osteoporosis treatment) translated to ten dose years of bisphosphonate prescriptions filled, given the propensity for treatment gaps and low refill compliance with bisphosphonates.
The study population was all persons aged 35 and above, who had filled at least one prescription for an oral bisphosphonate in the year 2008. Past use of osteoporosis medications (bisphosphonates, raloxifene, strontium ranelate, or PTH analogs) for the period January 1, 1995 to December 31, 2007 was retrieved from the Danish National Prescription Database for descriptive analysis.
Of the 58,674 BP users, 46 % were above the age of 75, and 13 % were men. Though 5.9 % had at least a 10-year history of treatment, only half (2.8 %) had received more than ten dose years of a BP. For any osteoporosis drug, 3.0 % had received ten dose years or more, while 23.2 % had received between 5 and 10 years of treatment.
Long-term users with ten dose years or more of a BP are rare due to periods of low compliance and gaps, with a discrepancy between the length of treatment and doses taken. The study also highlights the great number of patients who have used BP for more than five dose years and should be advised on length of treatment, a decision process that will be difficult due to the paucity of long-term safety and efficacy data.
PubMed ID
22572963 View in PubMed
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Associated response in bone and lipids during hormone replacement therapy.

https://arctichealth.org/en/permalink/ahliterature182171
Source
Maturitas. 2004 Jan 20;47(1):39-45
Publication Type
Article
Date
Jan-20-2004
Author
Anne Bloch Thomsen
Sandra Silvestri
Jens Haarbo
Claus Christiansen
Nina H Bjarnason
Author Affiliation
Center of Clinical Basic Research, Ballerup Byvej 222, 2750 Ballerup, Denmark. abt@ccbr.dk
Source
Maturitas. 2004 Jan 20;47(1):39-45
Date
Jan-20-2004
Language
English
Publication Type
Article
Keywords
Biological Markers - blood - urine
Bone Density - drug effects
Cholesterol, LDL - drug effects
Denmark
Double-Blind Method
Estradiol - pharmacokinetics - therapeutic use
Estrogen Replacement Therapy - methods
Female
Follow-Up Studies
Humans
Middle Aged
Norpregnenes - pharmacokinetics - therapeutic use
Osteoporosis, Postmenopausal - drug therapy - prevention & control
Progestins - pharmacokinetics - therapeutic use
Prospective Studies
Regression Analysis
Treatment Outcome
Abstract
In postmenopausal women, we investigated if the response in bone mineral density (BMD) was associated with the response in the atherogenic lipid profile during hormone replacement therapy.
We performed an exploratory, post-hoc analysis of data from a prospective double-blind placebo-controlled trial. Healthy postmenopausal women were randomised into five groups, each receiving different combinations of 17 beta-estradiol and gestodene or placebo. A total of 133 women completed the study. The study period was 3 years. The response in bone mass was expressed as the percentage change in BMD from baseline calculated by linear regression from semi-annual measurements. The change in lipid profile was evaluated as the average of three mid-cycle and end-cycle values in percentage from baseline in order to account for cyclic changes during sequential hormone therapy.
A significant correlation between the increase in BMD of the spine and hip and forearm with the decrease in serum low density lipoprotein (LDL) and cholesterol was found. Additionally, the decrease in atherogenic lipids correlated significantly with the response in biochemical bone markers for resorption and formation.
In conclusion, our study shows that it is the same women who have a favourable response in BMD as in the lipid-profile during hormone replacement therapy (HRT). The association is most likely driven by a common response in FSH to exogenous estradiol therapy. This indicates that common denominators for the response to HRT exist. Further studies are needed to explore and identify such predictors.
PubMed ID
14706764 View in PubMed
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Associations between grip strength change and axial postmenopausal bone loss--a 10-year population-based follow-up study.

https://arctichealth.org/en/permalink/ahliterature173600
Source
Osteoporos Int. 2005 Dec;16(12):1841-8
Publication Type
Article
Date
Dec-2005
Author
Joonas Sirola
Marjo Tuppurainen
Risto Honkanen
Jukka S Jurvelin
Heikki Kröger
Author Affiliation
Bone and Cartilage Research Unit, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland. joonas.sirola@uku.fi
Source
Osteoporos Int. 2005 Dec;16(12):1841-8
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon - methods
Bone Density - physiology
Estrogen Replacement Therapy
Female
Femur Neck
Finland - epidemiology
Follow-Up Studies
Hand Strength - physiology
Humans
Lumbar Vertebrae
Middle Aged
Osteoporosis, Postmenopausal - drug therapy - epidemiology - physiopathology
Perimenopause - physiology
Prospective Studies
Abstract
The aim of the present study was to investigate the associations between grip strength change and postmenopausal bone loss. The study population, 622 peri- and postmenopausal women, was a random sample of the OSTPRE-study cohort (n=13,100) in Kuopio, Finland. Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured with dual X-ray absorptiometry and grip strength with a pneumatic squeeze dynamometer at baseline in 1989-1991, at the 5-year follow-up in 1994-1997 and at the 10-year follow-up in 1999-2001. Women were divided into three groups according to the change in age-grouped grip strength quartile they belonged to in each measurement (n in 5-year/10-year follow-up): "decreased" (n=150/n=140), "maintained" (n=314/n=320) and "improved" (n=158/n=162). Women within the improved group had significantly lower bone loss at both FN and LS in comparison to the other two groups after 10 years of follow-up (P
PubMed ID
16049626 View in PubMed
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Attitudes and beliefs of family physicians and gynecologists in relation to the prevention and treatment of osteoporosis.

https://arctichealth.org/en/permalink/ahliterature208115
Source
J Bone Miner Res. 1997 Jul;12(7):1100-7
Publication Type
Article
Date
Jul-1997
Author
M. Suarez-Almazor
J E Homik
D. Messina
P. Davis
Author Affiliation
Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
Source
J Bone Miner Res. 1997 Jul;12(7):1100-7
Date
Jul-1997
Language
English
Publication Type
Article
Keywords
Alberta
Attitude
Bone Density
Clinical Competence
Data Collection
Estrogen Replacement Therapy
Family Practice
Female
Gynecology
Humans
Middle Aged
Osteoporosis, Postmenopausal - drug therapy - prevention & control
Abstract
The objective of this study was to evaluate the attitudes and beliefs of primary care physicians (PCPs) and obstetricians/gynecologists (O&Gs) in relation to the prevention and treatment of osteoporosis (OP) in postmenopausal women. A survey was mailed to a random sample of PCPs and to all O&Gs registered in the province of Alberta (Canada). The survey evaluated their practice patterns using closed-ended questions, Likert scaled items, and two case studies. Cases 1 and 2 were 52-year-old and 62-year-old healthy postmenopausal women, respectively, with no known risks for OP. Neither had received hormone replacement therapy (HRT). One hundred fifty-seven PCPs and 57 O&Gs participated in the study. Thirty-eight percent of the PCPs and 32% of the O&Gs stated that they never requested bone mineral density measurements (BMDm) in early postmenopausal women. Most would request BMDm only in the presence of risk factors. The most important criteria to request BMDm were chronic glucocorticoid use and recent fractures. For case 1, 7% of the PCPs and 11% of the O&Gs would request BMDm; 76% of the PCPs and 80% of the O&Gs would recommend HRT. For case 2, 29% of the PCPs and 47% of the O&Gs would request BMDm (p = 0.01); 43% of the PCPs and 49% of the O&Gs would prescribe HRT. In general, O&Gs were more inclined to intervene in relation to BMDm and HRT. O&Gs were also more likely to be influenced by clinical trials than PCPs (p
PubMed ID
9200010 View in PubMed
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Bisphosphonate prescribing, persistence and cumulative exposure in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature134290
Source
Osteoporos Int. 2012 Mar;23(3):1075-82
Publication Type
Article
Date
Mar-2012
Author
A M Burden
J M Paterson
D H Solomon
M. Mamdani
D N Juurlink
S M Cadarette
Author Affiliation
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada M5S 3M2.
Source
Osteoporos Int. 2012 Mar;23(3):1075-82
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Bone Density Conservation Agents - administration & dosage - therapeutic use
Diphosphonates - administration & dosage - therapeutic use
Drug Prescriptions - statistics & numerical data
Drug Substitution - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Medication Adherence - statistics & numerical data
Ontario
Osteoporosis - drug therapy - psychology
Osteoporosis, Postmenopausal - drug therapy - psychology
Physician's Practice Patterns - statistics & numerical data
Time Factors
Abstract
We studied new users of oral bisphosphonates and found that less than half persisted with therapy for 2 years, and interruptions in use were common. During a median observation period of 4.7 years, 10% of patients filled only a single prescription, 37% switched therapies and median cumulative exposure was 2.2 years.
We sought to describe bisphosphonate prescribing, persistence and cumulative exposure among seniors in Ontario, Canada.
We used Ontario Drug Benefit pharmacy claims to identify residents aged = 66 years who initiated oral bisphosphonate therapy between April 1996 and March 2009. The first date of bisphosphonate dispensing was considered the index date. Persistence with therapy was defined as continuous treatment with no interruption exceeding 60 days. We examined persistence with therapy and the number of extended gaps (>60 days) between prescriptions over time periods ranging from 1 to 9 years. We also identified the proportion of patients filling only a single prescription and switching to a different bisphosphonate, and calculated the median days of exposure irrespective of gaps in therapy.
A total of 451,113 eligible new bisphosphonate users were identified: mean age = 75.6 years (SD = 6.9), 84% female, and median follow-up length = 4.7 years. Persistence with therapy declined from 63% at 1 year to 46% at 2 years and 12% at 9 years. Among those with at least 5 years of follow-up (n = 213,029), 61% had one or more extended gaps in bisphosphonate therapy. Overall, 10% of patients filled only a single prescription, 37% switched to a different bisphosphonate and the median exposure was 2.2 years.
Less than half of patients persisted with bisphosphonate therapy for 2 years and interruptions in therapy were common, with most patients experiencing two or more >60-day gaps in therapy. Interventions are needed to improve persistence with bisphosphonate therapy and reduce the frequency of gaps in treatment.
Notes
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PubMed ID
21604008 View in PubMed
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43 records – page 1 of 5.