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After ‘rapid increase,’ anti-osteoporosis prescriptions decline for UK women
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After more than a decade of steep increases, the rate of first prescriptions for any oral anti-osteoporosis drug for women in the United Kingdom declined more than 12% between 2009 and 2012, according to a retrospective database analysis.
In an observational study using data from the UK Clinical Practice Research Datalink, researchers also observed a plateau in first prescriptions of oral anti-osteoporosis drugs for men from 2006 onward.
“We observed that the incidence of oral [bisphosphonate] prescriptions no longer increased after 2006, and in women even decreased from 2009 onwards, although potentially stabilized from 2011 to 2012,” Cyrus Cooper, OBE, MA, DM, FRCP, FFPH, FMedSci, director of the MRC life-course epidemiology unit at University of Southampton, and colleagues wrote. “Whilst the decrease in prescribing amongst women is relatively modest, the downward trend is concerning and is consistent with the results of other studies.”
Cooper and colleagues analyzed prescription data from women and men aged at least 50 years recorded in the Clinical Practice Research Datalink (CPRD) between 1990 and 2012. All prescriptions for anti-osteoporosis drugs, including oral bisphosphonates and strontium ranelate, were identified; IV bisphosphonates, such as zoledronic acid, were not captured in the database; and rates of prescriptions for teriparatide, denosumab and calcitonin were too low for analysis. Researchers followed patients from index date to first prescription for any osteoporosis drug.
Among women, researchers observed a “rapid increase” in the rate of first anti-osteoporosis drug prescriptions between 1990 and 2002, from 2.3 prescriptions per 10,000 patient-years in 1990 to 169.7 per 10,000 patient-years in 2006. The rate then plateaued, followed by a 12.4% decrease in the last 3 years, from 173.8 per 10,000 patient-years in 2009 to 152.2 per 10,000 patient-years in 2012.
Among men, researchers observed an increase from 1990 until 2007, from 1.4 prescriptions per 10,000 patient-years to 45.3 per 10,000 patient-years, followed by a plateau.
Researchers also observed regional and ethnic differences in prescription rates; women and men in Northern Ireland were more likely to be prescribed anti-osteoporosis drugs, whereas women living in the East Midlands and men living in Yorkshire were the least likely to be prescribed osteoporosis therapy. Among black women, the rate of first prescription for anti-osteoporosis therapy was 46% of that in white and Asian women, according to researchers.
Researchers attributed the plateau and decrease in prescriptions to a possible fear of the side effects of bisphosphonate therapy.
“Now that we have randomized controlled trials using established risk algorithms, such as FRAX, to target osteoporosis therapies, which demonstrate the effectiveness and cost-utility of these strategies on hip fracture prevention, we need to strengthen the available primary and secondary guidance for their use in a population setting,” Cooper told Endocrine Today. “Adjunctive approaches, such as instatement of coordinator-based secondary fracture prevention systems, appropriate communication of the major benefits and extremely infrequent risks to therapy, attention to adherence and incorporation of therapeutic targets will assist in this endeavor.
“Having moved osteoporosis from being a universal accompaniment of aging, to a disorder whose pathology we understand, whose risk we can measure, and whose outcome we can prevent, it seems unfortunate that we have regressed to a situation in which risk is not widely assessed, and the risk-benefit balance of appropriate intervention is miscommunicated,” Cooper said. –by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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Timothy Bhattacharyya
This interesting study from the United Kingdom showed that initiation of bisphosphonates by women rose steeply until 2008 and then promptly declined by 12%. These data largely parallel the studies of prescription trends in the U.S., Canada and Australia. Because they used a prospective, individual-level database, the data are highly reliable. Unlike other studies, the authors were able to specifically observe a decline in the initiation of therapy.
These data are very concerning. There is no evidence that osteoporosis is disappearing, and in the National Health Services prescription costs are not a factor, so the sharp reduction in bisphosphonate prescription initiation is clearly driven by the safety concerns that arose in 2008 and 2009. Deceased treatment of osteoporosis with bisphosphonates is a global phenomenon. A rise in osteoporotic fractures can’t be far behind.
Disclosure: Bhattacharyya reports no relevant financial disclosures.
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