title: Pharmaceutical care issues encountered by post-menopausal osteoporotic women prescribed bisphosphonates.
abstract: OBJECTIVE
  Pharmacists have been involved in providing comprehensive interventions to osteoporosis patients, but pharmaceutical care issues (PCIs) encountered during such interventions have not been well documented. Therefore, the aim of this study was to document PCIs encountered by post-menopausal osteoporotic women prescribed bisphosphonates.
  
  
  METHODS
  A randomized controlled study was conducted from September 2005-February 2009 in the University Malaya Medical Centre, Malaysia. This main intervention study measured the effects of pharmaceutical care on medication adherence, persistence, quality of life, knowledge and patient satisfaction. However, this manuscript is part of the main intervention study and focuses only on the PCIs encountered.
  
  
  METHODS
  post-menopausal women diagnosed with osteoporosis (T-score≤-2·5/low-trauma fracture) and prescribed weekly alendronate/risedronate.
  
  
  METHODS
  those with metabolic bone disease and could not communicate in English. The PCIs identified were collected via personal interviews or telephone calls, and each participant was followed-up for a period of 2 years. All PCIs were discussed with and confirmed by a physician.
  
  
  CONCLUSIONS
  Of the 198 participants recruited, 64 (32·3%) experienced adverse effects because of bisphosphonates whereas one participant (0·5%) refused to start bisphosphonates because of fear of adverse effects. Most adverse effects [50 (74·6%)] were reported during the first 3 months of therapy with gastrointestinal problems being the main issue [23 (11·6%)]. Of the nine participants (4·5%) who discontinued bisphosphonates, only three agreed to take another medication. From the 97 PCIs identified, 77 issues could be classified as drug-related problems [according to the Pharmaceutical Care Network Europe Classification v6·2]. There were 87 causes, 178 interventions and 77 outcomes. The main problem and cause of the PCIs encountered were adverse drug events (83·1% and 74·7% respectively), whereas the main intervention provided was patient counselling (41·0%). All problems were solved (98·5%) except for one because of the lack of cooperation of a patient. After 2 years, 36 participants (20%) were no longer persistent with therapy, 19 (10·6%) did not have clinic follow-up and 53 (26·8%) did not have a bone mineral density scan.
  
  
  CONCLUSIONS
  The main PCIs identified were related to the use of bisphosphonates and its adverse effects. The study showed that the presence of a clinical pharmacist has enabled patients to voice their medication-related issues and to allow appropriate recommendations and actions to be taken to resolve these issues.
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. plai@ummc.edu.my
authors.forename: P S M
authors.initials: PS
authors.lastname: Lai
authors.forename: S S
authors.initials: SS
authors.lastname: Chua
authors.forename: S P
authors.initials: SP
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D012968:Etidronic Acid / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008296:Malaysia; D055118:Medication Adherence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods; D017060:Patient Satisfaction; D010593:Pharmaceutical Services; D011788:Quality of Life; D000068296:Risedronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate