Objective: This study assessed the burden of concomitant medication (con-med) use among women with postmenopausal osteoporosis receiving bisphosphonate therapy. Postmenopausal osteoporosis is a highly prevalent condition particularly among elderly women, who are also likely to experience several comorbid chronic conditions such as hypertension, hypercholesterolemia, and diabetes.
Methods: A HIPAA-compliant, longitudinal patient database (NDCHealth, Atlanta, Georgia) was used to determine which products or product classes were used concomitantly with alendronate (5, 10, 35 or 70mg) or risedronate (5 or 35mg), and how many of these medications were used by each patient. Con-meds included prescription medicines administered by mouth, inhaled or intranasal medicines or those self-administered by parenteral injection. Prescription information covered 14,000 US retail pharmacies (~25% of US retail pharmacies) and patient data were assessed on a monthly basis over a 56-month period (November 1999-June 2004) in women ≥50 years old receiving bisphosphonate therapy.
Results: The total number of women eligible for analysis increased from 78,909 in November 1999 to 250,286 in June 2004. The average number of con-meds over time was greater for daily (3.14 in November 1999 to 4.16 in June 2004) than for weekly bisphosphonate patients (3.64 in Nov. 2000 to 3.77 in June 2004). The majority (~65%) of women who were taking daily or weekly bisphosphonates and con-meds were prescribed between 1–3 con-meds. A further ~12% of this group received 4 con-meds, ~8% received 5 con-meds, and ~17% received ≥6 con-meds. The number of con-meds used increased with age, ranging from 2.74–3.09 for women aged 50–64 years, up to 3.16–3.97 for women aged ≥75 years. The most common con-meds included levothyroxine sodium, atorvastatin calcium, atenolol, furosemide, amlodipine besylate, potassium chloride, hydrochlorothiazide, and lisinopril. The most common concomitant product classes included cholesterol reducing agents, synthetic thyroid hormones, beta blockers, calcium channel blockers, ACE inhibitors, and systemic antiarthritics.
Conclusions: The number of con-meds prescribed to women with postmenopausal osteoporosis continues to increase over time suggesting a considerable, high medication burden among these patients. Women prescribed daily bisphosphonates receive more con-meds than those prescribed weekly bisphosphonates and the number of con-meds increases with age. This may be particularly problematic when, generally, many medications are taken in the morning, conflicting with fasting and administration requirements of bisphosphonates. The high level of con-med use and the severity of the other conditions commonly being treated (hypercholesterolemia, hypothyroidism, heart failure and hypertension) highlights the importance of considering more convenient medication options for osteoporosis patients. These patients obviously bear a substantial medication burden, which may in part explain why persistence with bisphosphonate therapy remains suboptimal1.
1. Ettinger M, et al. Arthritis Rheum 2004;15(Suppl):S513
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Faculty Member's Name: Deborah T. Gold, PhD
Consultant: GlaxoSmithKline and Roche
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