A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England

被引:12
|
作者
Chalitsios, Christos, V [1 ]
Shaw, Dominick E. [1 ]
McKeever, Tricia M. [2 ]
机构
[1] Univ Nottingham, NIHR Div Resp Med, Nottingham, England
[2] Univ Nottingham, Div Epidemiol & Publ Hlth, Nottingham, England
关键词
OSTEOPOROSIS DRUG PRESCRIPTION; INHALED CORTICOSTEROIDS; FRAGILITY FRACTURES; RISK; CARE; THERAPY; RECOMMENDATIONS; PREVENTION; MANAGEMENT; EXPOSURE;
D O I
10.1038/s41533-020-0162-6
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect negative binomial regression analysis. There was a rise in OCS and BP prescriptions of 55% and 1200% from 1998 to 2018, respectively. Of the 6586 included practices, the median (IQR) of OCS and BP prescriptions were 120.8 (84.8-160.4) and 107.7 (73.8-147.4) per 1000 patients, respectively. Asthma and chronic obstructive pulmonary disease (COPD) were significantly associated with OCS use (p < 0.0001), but only COPD was associated with BP use (p < 0.0001). Higher OCS prescribing rates were associated with higher BP prescribing rates (5th to 1st quintile-IRR = 1.99; 95% CI: 1.88-2.10). Practice list size, deprivation and advanced age were all associated with both drugs (p < 0.0001). In conclusion, although OCS use is positively associated with BP prescription, variation among practices and CCGs exists. The variation in prescribing suggests there is still a need to improve GIOP prevention.
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页数:8
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