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- Title
Factors associated with initiation of bone-health medication among older adults in primary care in Ireland.
- Authors
Walsh, Mary E; Nerdrum, Mari; Fahey, Tom; Moriarty, Frank
- Abstract
Background Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common. Objective This study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care. Design This was a retrospective cohort study. Setting The study used data from forty-four general practices in Ireland from 2011–2017. Subjects The study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months. Methods Overall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution. Results Of 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17–1.50), P < 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17–1.44), P < 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association. Conclusions Bone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those >80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.
- Subjects
IRELAND; OSTEOPOROSIS prevention; BONE fracture prevention; BONE physiology; CONFIDENCE intervals; BONE resorption; RETROSPECTIVE studies; REGRESSION analysis; MANN Whitney U Test; PRIMARY health care; PREVENTIVE health services; T-test (Statistics); DRUGS; DESCRIPTIVE statistics; BONE density; DATA analysis software; LONGITUDINAL method; POISSON distribution; OLD age
- Publication
Age & Ageing, 2021, Vol 50, Issue 5, p1649
- ISSN
0002-0729
- Publication type
Article
- DOI
10.1093/ageing/afab033