Pharmaceutical treatment of symptomatic vertebral fractures in primary care.
BACKGROUND
Vertebral fractures are associated with a reduction in quality of life and are an important predictor of other non-spine fractures. Previous work has shown that up to 60% of patients with a vertebral fracture identified in primary care remain untreated.


OBJECTIVE
To examine the prevalence of pharmaceutical treatment and predictors of treatment in a primary care setting.


METHODS
Case-control study using the general practice research database (GPRD). All women aged 50 years and over with a first diagnosis of a vertebral fracture since 1990 were identified and matched with a control by age and practice. Appropriate use of a pharmaceutical agent was defined as a prescription occurring within 30 days of the diagnosis being recorded.


RESULTS
We identified 2719 women with the same number of controls. Within 30 days of diagnosis 61% of women were prescribed treatment, compared with only 3% of the controls. Bisphosphonate was the single most important treatment prescribed. Predictors of any drug treatment included: year of fracture (most recent year increased the likelihood of treatment); age (younger patients were more likely to receive treatment); history of back pain; low body weight; history of steroid use.


CONCLUSIONS
Treatment of diagnosed vertebral fractures is becoming more common. Treated patients tend to be younger but to have a higher prevalence of clinical risk factors than untreated patients. There remain significant numbers of patients who are not offered treatment.
Torgerson
D J
DJ
Department of Health Sciences, University of York, York YO10 5DD. djt6@york.ac.uk
Sykes
D
D
Puffer
S
S
Brown
P
P
Cooper
C
C
D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D004164:Diphosphonates / Q000627:therapeutic use*; D005194:Family Practice; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D018579:Patient Selection; D016103:Spinal Fractures / Q000188:drug therapy*; D013997:Time Factors
D004164:Diphosphonates; D005938:Glucocorticoids