title: Reasons for bisphosphonate exclusion in patients treated for osteoporosis.
abstract: OBJECTIVE
  Inadequate treatment is a concern in management of osteoporosis because of its negative impact on fracture risk, health care costs, and quality of life. Bisphosphonates are the most effective drug class at decreasing hip and spine fractures. The purpose of the study was to discover reasons for exclusion of bisphosphonates in the treatment of patients with osteoporosis.
  
  
  METHODS
  A cross-sectional study of electronic medical records.
  
  
  METHODS
  Academic family medicine outpatient clinics.
  
  
  METHODS
  Subset of patients older than 25 years of age who had a diagnosis of osteoporosis and were not on bisphosphonate treatment on December 31, 2007.
  
  
  RESULTS
  The primary endpoint was the reason patients were not on bisphosphonate therapy. Secondary endpoints included the length of previous bisphosphonate therapy and the number of patients receiving other prescription treatments for osteoporosis.
  
  
  RESULTS
  Of 698 patients with osteoporosis, 418 (60%) were not treated with a bisphosphonate. Patients were 91.6% female and 76.4% white, with a mean age of 77.5 ± 13.5 years. Of the random sample of 191 patients, 17 (8.9%) patients did not have an identifiable reason for bisphosphonate exclusion. The most common reasons were gastrointestinal (GI) diagnosis (28%), low functional status (24%), and poor renal function (12%). Almost half (44.5%) of patients were previously on a bisphosphonate, with an average use of 20.7 ± 17.7 months. Only 2.6% of patients received osteoporosis treatment other than a bisphosphonate.
  
  
  CONCLUSIONS
  Even though 60% of patients were not prescribed a bisphosphonate, 91.1% had a reason for exclusion. With GI reasons most common, parenteral forms of bisphosphonates recently approved for osteoporosis may increase use.
authors: Campbell University, East Carolina University, Greenville, North Carolina.
authors: Oxana
authors: O
authors: Kamneva
authors: Ann Marie
authors: AM
authors: Nye
authors: Irene
authors: I
authors: Hamrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003704:Dementia / Q000150:complications; D004164:Diphosphonates / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D057240:Patient Preference
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates