Prescription For Osteoporosis Medication Research Articles

Correlations of nursing home characteristics with prescription of osteoporosis medications

Background Osteoporosis is highly prevalent in the nursing home (NH) populations but medications that increase bone mineral density are used infrequently. Prior research finds few patient characteristics predict treatment. NH characteristics have been associated with prescription of some medications. We examined associations of NH-level characteristics with osteoporosis treatment in elderly patients admitted to a NH after a fracture. Method We conducted a cohort study of patients with hip, wrist and humeral fractures admitted to a NH in NJ. They were followed for 12 months from 1999 to 2004. Possible NH-level predictors of receiving osteoporosis treatment were assessed in mixed multivariable models to account for clustering within individual NHs. Results Of the 2838 post-fracture patients identified from 180 NHs, 156 (5.5%) were prescribed an osteoporosis medication. There was wide variation in treatment between individual NHs (0–40%), which was substantially reduced after adjusting for patient case mix. Several patient characteristics did associate with osteoporosis treatment—female gender (odds ratio (OR) 2.56, 95% confidence interval (CI) 1.42, 4.61), younger age per year (OR 0.98, 95%CI 0.96, 0.99), white race (OR 2.37, 95%CI 1.23, 4.56) and prior history of fracture (OR 4.41, 95%CI 1.04, 18.73). However no NH characteristics significantly associate with treatment (profit status, NH chain member, occupancy rate, and bed size). Conclusion NH characteristics did not predict pharmacological treatment of osteoporosis. Further studies of osteoporosis prescribing in NHs need to consider other types of variables as possible correlates of prescribing.

Improving prescribing of antiosteoporosis discharge medication in fractured neck of femur patients: a completed audit cycle

Fracture liaison specialist nurses at our institute, perceived deficiency in the level of prescription of osteoporosis secondary prevention medication on discharge of fractured neck of femur (NOF) patients. This aspect of management was therefore audited over two cycles with the aim of evaluating and improving current practice. A prospectively maintained database was utilized to establish identity, demographic data and specialist nurse treatment recommendation for all fractured NOF patients over an initial 12-month period. Computerized immediate discharge letters were reviewed to identify whether the recommended medication had been prescribed. Following the initial audit, fluorescent drug kardex stickers detailing simple treatment recommendations were introduced, and a second audit cycle was carried out using identical methods over the subsequent 12-month period. Primary audit demonstrated that discharge prescriptions included the recommended secondary prevention medications in 50.9%. Following the introduction of fluorescent drug chart stickers detailing the recommendations, re-audit demonstrated improvement to 84.6%. In conclusion, an improvement in the practice of prescription of osteoporosis medications on discharge was demonstrated following the introduction of fluorescent drug kardex stickers.

A Before-and-After Study of Fracture Risk Reporting and Osteoporosis Treatment Initiation

Several national organizations recommend that fracture risk assessment and osteoporotic treatment be based on estimated absolute 10-year fracture risk rather than bone mineral density (BMD) alone. To assess the changes in physician prescribing behavior after introduction of absolute 10-year fracture risk reporting. Before-and-after study. Manitoba, Canada, which has an integrated BMD program in which tests are linkable to a population-based administrative health database repository. Women 50 years or older who were not receiving osteoporosis medication (2042 before and 3889 after intervention). Introduction of a system reporting absolute 10-year fracture risk along with dual-energy x-ray absorptiometry results. The proportion of untreated women who were prescribed osteoporosis medications in the year after baseline BMD measurement. Absolute fracture risk reporting reclassified more women (32.7%) into lower-risk categories than into higher-risk categories (10%). This effect was more prominent in women younger than 65 years. Fewer women per physician were prescribed osteoporosis drugs after introduction of absolute fracture risk reporting. The absolute fracture risk reporting system was associated with an overall reduction in osteoporosis medications dispensed (adjusted absolute reduction, 9.0 percentage points [95% CI, 3.9 to 14.2 percentage points]; relative reduction, 21.3% [CI, 9.2% to 33.5%]; P < 0.001). The reduction was attributed to fewer drugs dispensed to women at low and moderate risk for fracture. No differences in fracture rates were observed. This was a nonrandomized study. The risk assessment system studied differs slightly from other 10-year fracture risk assessment models. Change from a T-score-based fracture risk reporting system to a system based on absolute 10-year fracture risk was associated with appropriate, guideline-based changes in prescription of osteoporosis medications. None.

Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial

This study evaluated the effect of a multifaceted intervention (screening and patient education) by community pharmacists on testing or treatment of osteoporosis. One hundred and twenty-nine patients randomized to receive the intervention were compared to 133 patients who did not receive the intervention. Twice as many patients who got the intervention received further testing or treatment for osteoporosis. The objective of this study was to determine the effect of a community pharmacist screening program on testing and treatment of osteoporosis. In this randomized, controlled trial, 262 patients meeting bone mineral density (BMD) testing guidelines [men or women aged > or = 65 years or 50-64 years with one major risk factor including previous fracture, family history of osteoporosis, glucocorticoids for > 3 months, or early menopause] were allocated to intervention (129) or control (133). Intervention consisted of printed materials, education, and quantitative ultrasound. Primary outcome was a composite endpoint of BMD or prescription for osteoporosis medication within 4 months. Primary endpoint of BMD or osteoporosis treatment was achieved by 28 intervention patients (22%) compared with 14 controls (11%) (RR 2.1, 95% CI 1.1-3.7). This was driven by BMD testing (28 (22%) vs. 13 (10%) for controls, p = 0.011). Calcium intake increased more among intervention patients than controls (30% vs. 19%, RR 1.6, 95% CI 1.0-2.5). There was no effect on knowledge or quality of life. A pharmacist screening program doubled the number of patients tested for osteoporosis. Nevertheless, many patients eligible for BMD did not receive appropriate care suggesting more intensive interventions are needed.

TS02 IMPROVING THE OSTEOPOROSIS CARE GAP IN ELDERLY PATIENTS FOLLOWING HIP FRACTURES FOR THE ICHIBAN INITIATIVE

Problem: There are low rates of treatment of osteoporosis following hip fractures in the elderly.Design: Controlled before‐after trial of the ortho‐geriatric‐led ‘ICHIBAN’ program. Data were collected by a blinded observer in 2 phases: over the year before and 10‐months following intervention. The data is collected from orthopaedic wards in a large metropolitan hospital.Improvement Measures: Rate of measurement: 25‐hydroxyvitamin levels (25‐OHD), thyroid‐stimulating hormone (TSH), and parathyroid hormone (PTH). Prescription of osteoporosis medications (vitamin D, calcium supplements, oral bisphosphonates). Documentation of rationale for non‐prescription.Conclusion: Three‐hundred‐and‐fifty‐two patients presented during a period of 22‐months: 202 during 12‐months prior to and 150 in the 10 months following intervention. Investigation of 25‐hydroxyvitamin levels increased from 31.6% to 71.2%, focused tests for secondary osteoporosis (TSH, PTH) from 9.4% to 37.1%, prescription of osteoporosis medications improved from 40.1% to 78.2% for vitamin D, 41.3% to 75.6% for calcium supplements and 34.8% to 53.8% for oral bisphosphonates (p &lt; 0.001). Ninety percent documented rationale for non‐prescription of treatment. A 6‐month follow‐up of the first 60 patients following intervention showed that 51.6% were still on appropriate treatment. The ICHIBAN program has improved delivery of osteoporosis care to appropriate at‐risk patients following hip fracture.

Relationship between compliance and persistence with osteoporosis medications and fracture risk in primary health care in France: A retrospective case—control analysis

Background: Nonadherence to treatment is an important determinant of long-term outcomes in women with osteoporosis. Objectives: This study was conducted to investigate the association between adherence and osteoporotic fracture risk and to identify optimal thresholds for good compliance and persistence. A secondary objective was to perform a preliminary evaluation of the cost consequences of adherence. Method: This was a retrospective case-control analysis. Data were derived from the Thales prescription database, which contains information on >1.6 million patients in the primary health care setting in France. Cases were women aged ≥50 years who had an osteoporosis-related fracture in 2006. For each case, 5 matched controls were randomly selected. Both compliance and persistence aspects of treatment adherence were examined. Compliance was estimated based on the medication possession ratio (MPR). Persistence was calculated as the time from the initial filling of a prescription for osteoporosis medication until its discontinuation. Results: The mean (SD) MPR was lower in cases compared with controls (58.8% [34.7%] vs 72.1% [28.8%], respectively; P < 0.001). Cases were more likely than controls to discontinue osteoporosis treatment (50.0% vs 25.3%; P < 0.001), yielding a significantly lower proportion of patients who were still persistent at 1 year (34.1% vs 40.9%; P < 0.001). MPR was the best predictor of fracture risk, with an area under the receiver-operating-characteristic curve that was higher than that for persistence (0.59 vs 0.55). The optimal MPR threshold for predicting fracture risk was ≥68.0%. Compared with less-compliant women, women who achieved this threshold had a 51% reduction in fracture risk. The difference in annual drug expenditure between women achieving this threshold and those who did not was approximately €300. The optimal threshold for persistence with therapy was at least 6 months. Attaining this threshold was associated with a 28% reduction in fracture risk compared with less-persistent women. Conclusions: In this study, better treatment adherence was associated with a greater reduction in fracture risk. Compliance appeared to predict fracture risk better than did persistence.

Improving diagnosis and treatment of osteoporosis: evaluation of a clinical pathway for low trauma fractures

SummaryDiagnosis and treatment of osteoporosis in hospitals is poor. We compared patient outcomes before and after implementation of a clinical protocol for low-trauma fractures. Patients in the pathway were more likely to receive information about osteoporosis or osteoporosis medications. Therefore our clinical pathway is effective in improving osteoporosis information and treatment.IntroductionEffective therapies for reducing fracture risk are available, yet under-utilised in hospital settings. We aimed to increase rates of initiation of osteoporosis investigations, pharmacological treatment, treatment continuation, and follow-up general practitioner (GP) visits.MethodsComparison of patient outcomes before and after implementation of a clinical pathway in patients admitted for low-trauma fractures to the Department of Orthopaedics and Trauma at The Queen Elizabeth Hospital, Adelaide.ResultsPatients enrolled in the osteoporosis clinical pathway (n = 28) were more likely than patients receiving usual care (n = 28) to have received information about (54% vs. 29%; p < 0.05), or a prescription for osteoporosis medication (53% vs. 25%, p < 0.05). Differences in proportions of patients visiting their GP post fracture and in osteoporosis investigations suggested or undertaken were not significant. At the later audit, the high proportion of patients receiving information about osteoporosis medication had been maintained (51%). Prescription of osteoporosis medications increased to 83% (p < 0.01), and more patients saw their GP post fracture (87%; p < 0.01). High rates of medication adherence were reported in patients in all groups receiving prescriptions.ConclusionA clinical pathway for improving hospital management of osteoporosis is effective in improving education about, prescription for, and uptake of osteoporosis medications.