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Comorbidities, bone-sparing agent prescription history and their determinants among postmenopausal women in UK primary care settings: a retrospective database study

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Abstract

Summary

Distinguishing oral bisphosphonates from other bone-sparing therapies, this retrospective observational study, first, characterized treated osteoporosis patients in the UK, and secondly, explored factors associated with the risk of discontinuation or switching between therapies. The latter should be considered when evaluating real-world data.

Purpose

This retrospective observational study evaluated the characteristics of women with postmenopausal osteoporosis, including comorbidities and determinants of treatment patterns with bone-sparing agents.

Methods

The UK Clinical Practice Research Datalink was used to identify postmenopausal women (aged ≥50 years) treated with a bone-sparing agent or diagnosed with osteoporosis between 1 January 1993 and 31 December 2008. Two non-mutually-exclusive subpopulations were defined: (1) patients active in the database on 31 December 2008; (2) patients treated with a bone-sparing agent since 1 January 1993. Subpopulation 1 was used to describe patient comorbidities and osteoporosis treatment history, and subpopulation 2 was used to explore the characteristics associated with bone-sparing treatment patterns use via multivariable regression for repeated multinomial responses.

Results

A total of 62,657 individuals met the inclusion criteria; subpopulation 1 comprised 38,469 women (61.4 %), of whom 21,687 received a bone-sparing agent in 2008 (99.7 % oral bisphosphonates and the remainder other agents). Those receiving other agents were more likely to have had previous treatment with bone-sparing agents, to have experienced previous fractures, and to have visited their doctor more frequently. Analyses also identified several comorbidities associated with an increased risk of discontinuation of bone-sparing agents, including heart disease, gastrointestinal disease, and renal failure. Anticonvulsant use was associated with a dramatic increase in the risk of switching.

Conclusions

Several patient characteristics were associated with discontinuation of, or switching between, bone-sparing treatments. Patients receiving bone-sparing medication other than oral bisphosphonates were more likely to have comorbid conditions and a history of fracture and to have taken an oral bisphosphonate previously.

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References

  1. Bouillon R, Burkhardt P, Christiansen C, Fleisch HA, Fujita T, Gennari C, Martin TJ, Mazzuoli G, Melton LJ, Ringe JD (1991) Consensus development conference: prophylaxis and treatment of osteoporosis. Osteoporos Int 1:114–117

    Article  Google Scholar 

  2. Scottish Intercollegiate Guidelines Network (2003) National Clinical Guideline 71: Management of osteoporosis. Available at: http://www.sign.ac.uk/pdf/sign71.pdf. Accessed July 2014

  3. American Association of Clinical Endocrinologists Osteoporosis Task Force (2001) American Association of Clinical Endocrinologists 2001 medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis. Endocr Pract 7:293–312

    Google Scholar 

  4. International Osteoporosis Foundation (2012) Europe guidelines. Available at: http://www.iofbonehealth.org/europe-guidelines. Accessed 30 April 2014

  5. Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster JY, Borgstrom F, Rizzoli R, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Cramer A, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18:1023–1031

    Article  PubMed  CAS  Google Scholar 

  7. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541

    Article  PubMed  CAS  Google Scholar 

  8. Boivin GY, Chavassieux PM, Santora AC, Yates J, Meunier PJ (2000) Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women. Bone 27:687–694

    Article  PubMed  CAS  Google Scholar 

  9. Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352

    Article  PubMed  CAS  Google Scholar 

  10. Reginster JY, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R, Vertebral Efficacy with Risedronate Therapy (VERT) Study Group (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 11:83–91

    Article  PubMed  CAS  Google Scholar 

  11. Hooper MJ, Ebeling PR, Roberts AP (2005) Risedronate prevents bone loss in early postmenopausal women: a prospective, randomized controlled trial. Climacteric 8:251–262

    Article  PubMed  CAS  Google Scholar 

  12. Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, Cannata Y, Balogh A, Lemmel EM, Pors-Nielsen S, Rizzoli R, Genant HK, Reginster JY (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468

    Article  PubMed  CAS  Google Scholar 

  13. Cramer JA, Amonkar MM, Hebborn A, Altman R (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21:1453–1460

    Article  PubMed  CAS  Google Scholar 

  14. McCombs JS, Thibaud P, McLaughlin-Miley C, Shi J (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287

    Article  PubMed  CAS  Google Scholar 

  15. Netelenbos JC, Geusens PP, Ypma G, Buijs SJ (2011) Adherence and profile of non-persistence in patients treated for osteoporosis—a large-scale, long-term retrospective study in The Netherlands. Osteoporos Int 22:1537–1546

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Hadji P, Claus V, Ziller V, Intorcia M, Kostev K, Steinle T (2012) GRAND: the German retrospective cohort analysis on compliance and persistence and the associated risk of fractures in osteoporotic women treated with oral bisphosphonates. Osteoporos Int 23:223–231

    Article  PubMed  CAS  Google Scholar 

  17. Martin KE, Yu J, Campbell HE, Abarca J, White TJ (2011) Analysis of the comparative effectiveness of 3 oral bisphosphonates in a large managed care organization: adherence, fracture rates, and all-cause cost. J Manag Care Pharm 17:596–609

    PubMed  Google Scholar 

  18. Hoffmann F, Jung TI, Felsenberg D, Glaeske G (2008) Pattern of intravenous bisphosphonate use in outpatient care in Germany. Pharmacoepidemiol Drug Saf 17:896–903

    Article  PubMed  Google Scholar 

  19. Foster SA, Foley KA, Meadows ES, Johnston JA, Wang S, Pohl GM, Long SR (2007) Characteristics of patients initiating teriparatide for the treatment of osteoporosis. Osteoporos Int 19:373–377

    Article  PubMed  Google Scholar 

  20. Briesacher BA, Andrade SE, Harrold LR, Fouayzi H, Yood RA (2010) Adoption of once-monthly oral bisphosphonates and the impact on adherence. Am J Med 123:275–280

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  21. Abelson A, Ringe JD, Gold DT, Lange JL, Thomas T (2010) Longitudinal change in clinical fracture incidence after initiation of bisphosphonates. Osteoporos Int 21:1021–1029

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Middleton ET, Steel SA, Doherty SM (2007) The effect of prior bisphosphonate exposure on the treatment response to teriparatide in clinical practice. Calcif Tissue Int 81:335–340

    Article  PubMed  CAS  Google Scholar 

  23. Lawson DH, Sherman V, Hollowell J (1998) The general practice research database for the scientific and ethical advisory group. Q J Med 91:445–452

    Article  CAS  Google Scholar 

  24. Garcia Rodriguez LA, Perez Gutthann S (1998) Use of the UK general practice research database for pharmacoepidemiology. Br J Clin Pharmacol 45:419–425

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  25. Gallagher A, Rietbrock S, Olson M, van Staa TP (2008) Fracture outcomes related persistence and compliance with oral bisphosphonate. J Bone Miner Res 23:1569–1575

    Article  PubMed  Google Scholar 

  26. Rietbrock S, Olson M, van Staa TP (2009) The potential effects on fracture outcomes of improvements in persistence and compliance with bisphosphonates. Q J Med 102:35–42

    Article  CAS  Google Scholar 

  27. Jick H, Terris BZ, Derby LE, Jick SS (1992) Further validation of information recorded on a general practitioner based computerized data resource in the United Kingdom. Pharmacoepidemiol Drug Saf 1:347–349

    Article  Google Scholar 

  28. Walley T, Mantgani A (1997) The UK general practice research database. Lancet 350:1097–1099

    Article  PubMed  CAS  Google Scholar 

  29. Agresti A, Booth J, Hobert JP, Caffo B (2008) Random-effects modeling of categorical response data. Sociol Methodol 30:27–80

    Article  Google Scholar 

  30. Penning-van Beest FJ, Goettsh WG, Erkens JA, Herings RM (2006) Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis. Clin Ther 28:236–242

    Article  PubMed  CAS  Google Scholar 

  31. National Institute for Health and Care Excellence (2011) TA160 Osteoporosis – primary prevention. Available at: http://guidance.nice.org.uk/TA160. Accessed 30 April 2014

  32. National Institute for Health and Care Excellence (2011) TA161 Osteoporosis – secondary prevention. Available at: http://www.nice.org.uk/guidance/ta161/resources/ta161-osteoporosis-secondary-prevention-including-strontium-ranelate-understanding-nice-guidance2. Accessed 30 April 2014

  33. Watts NB, Worley K, Solis A, Doyle J, Sheer R (2004) Comparison of risedronate to alendonate and calcitonin for early reduction of nonvertebral fracture risk: results from a managed care administrative claims database. J Manag Care Pharm 10:142–152

    PubMed  Google Scholar 

  34. National Institute for Health and Care Excellence (2014) Osteoporosis overview. Available at: http://pathways.nice.org.uk/pathways/osteoporosis#content=view-node%3Anodes-secondary-prevention-of-osteoporotic-fragility-fractures-in-postmenopausal-women. Accessed 20 July 2015.

  35. Biskobing DM (2002) COPD and osteoporosis. Chest 121:609–620

    Article  PubMed  Google Scholar 

  36. Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health in older people 2010. Available at: https://www.rcplondon.ac.uk/sites/default/files/national_report.pdf. Accessed 20 July 2015

  37. Balasubramanian A, Brookhart MA, Goli V, Critchlow CW (2013) Discontinuation and reinitiation patterns of osteoporosis treatment among commercially insured postmenopausal women. Int J Gen Med 6:839–848

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rossini M, Bianchi G, Di Munno O, Giannini S, Minisola S, Sinigaglia L, Adami S, Treatment of Osteoporosis in clinical Practice (TOP) Study Group (2006) Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 914

  39. Blouin J, Dragomir A, Ste-Marie L, Fernandes JC, Perreault S (2007) Discontinuation of antiresorptive therapies: a comparison between 1998–2001 and 2002–2004 among osteoporotic women. J Clin Endocrinol Metab 92:887–894

    Article  PubMed  CAS  Google Scholar 

  40. Lo JC, Pressman AR, Omar MA, Ettinger B (2006) Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int 17:922–928

    Article  PubMed  CAS  Google Scholar 

  41. Solomon DH, Avorn J, Katz JN, Finkelstein JS, Arnold M, Polinski JM, Brookhart MA (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419

    Article  PubMed  Google Scholar 

  42. Dennison EM, Compston JE, Flahive J et al (2013) Effect of comorbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 50:1288–1293

    Article  Google Scholar 

  43. Ensrud KE (2013) Fracture risk in CKD. Clin J Am Soc Nephrol 8:1282–1283

    Article  PubMed  PubMed Central  Google Scholar 

  44. Nazareth I, King M, Haines A, Rangel L, Myers S (1993) Accuracy of diagnosis on general practice computer system. BMJ 307:32–34

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  45. Hippisley-Cox J, Bayly J, Potter J, Fenty J, Parker C. Evaluation of standards of care for osteoporosis and falls in primary care. 2007. Available at: http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/general-practice/evaluation-of-standards-of-care-for-osteoporosis-and-falls-in-primary-care. Accessed 30 April 2015

  46. Boonen S, Kay R, Cooper C, Haentjens P, Vanderschueren D, Callewaert F, Milisen K (2009) Osteoporosis management: a perspective based on bisphosphonate data from randomised clinical trials and observational databases. Int J Clin Pract 63:1792–1804

    Article  PubMed  CAS  Google Scholar 

  47. Soriano JB, Maier WC, Visick G, Pride NB (2001) Validation of general practitioner-diagnosed COPD in the UK general practice research database. Eur J Epidemiol 17:1075–1080

    Article  PubMed  CAS  Google Scholar 

  48. Li L, Roddam A, Ferguson S, Feudjo-Tepie M, Taylor A, Jick S (2014) Switch patterns of osteoporosis medication and its impact on persistence among postmenopausal women in the U.K. General Practice Research Database. Menopause 21:1106–1113

    Article  PubMed  Google Scholar 

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Acknowledgments

Writing assistance was provided by Oxford PharmaGenesis Ltd, funded by Amgen.

Conflicts of interest

The study was sponsored by Amgen Ltd and GlaxoSmithKline plc.

M. Feudjo-Tepie, S. Ferguson, A. Taylor, and C. Critchlow are all Amgen employees. A. Roddam is a GlaxoSmithKline plc employee, but was previously an Amgen employee. J. Bayly is an independent consultant, affiliated with the University of Derby. He has received consultation fees from Amgen.

Author information

Authors and Affiliations

  1. Amgen Ltd, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK

    M. Feudjo-Tepie

  2. Amgen Ltd, 240 Cambridge Science Park, Milton Road, Cambridge, CB4 0WD, UK

    S. Ferguson & A. Taylor

  3. GlaxoSmithKline PLC, Stockley Park West, 1-3 Iron Bridge Road, Uxbridge, Middlesex, UB11 1BT, UK

    A. Roddam

  4. University of Derby, Derby, DE22 1GB, UK

    J. Bayly

  5. Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA

    C. Critchlow

Authors
  1. M. Feudjo-Tepie
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  2. S. Ferguson
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  3. A. Roddam
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  4. A. Taylor
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  5. J. Bayly
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Correspondence to M. Feudjo-Tepie.

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Feudjo-Tepie, M., Ferguson, S., Roddam, A. et al. Comorbidities, bone-sparing agent prescription history and their determinants among postmenopausal women in UK primary care settings: a retrospective database study. Arch Osteoporos 10, 41 (2015). https://doi.org/10.1007/s11657-015-0233-4

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