title: Overuse and Underuse of Antiosteoporotic Treatments According to Highly Influential Osteoporosis Guidelines: A Population-Based Cross-Sectional Study in Spain.
abstract: Inappropriate prescribing of antiosteoporotic medications has been observed; however, the joint study of both overuse and underuse has barely been attempted. Spain, with its high utilization rates, constitutes a good example to assess differences in over and under use according to diverse highly-influential osteoporosis guidelines (HIOG) worldwide. We used data of a population-based cross-sectional study including 824 post-menopausal women ≥50 years old living in the city of Valencia, Spain and aimed to estimate the percentage of women eligible for treatment, and the proportion of overuse and underuse of antiosteoporotic treatment according to HIOG. The prevalence of antiosteoporotic treatment in postmenopausal women ≥ 50 in Valencia was 20.9% (95%CI:17.6-24.4). The type of antiosteoporotic drugs prescribed varied greatly depending on the medical specialty responsible of the initial prescription. When applying the HIOG, the percentage of women 50 and over who should be treated varied from less than 9% to over 44%. In real terms, from the approximately eight million women of 50 years old and over in Spain, the number eligible for treatment would range from 0.7 to 3.8 million, depending on the guideline used. A huge proportion of inappropriate treatments was found when applying these guidelines to the Spanish population, combining a high overuse (42-78% depending on the guideline used) and underuse (7-41%). In conclusion, we found that the pharmacological management of osteoporosis in women of 50 and over in this population combines an important overuse and, to a lesser extent, underuse, although the level of inappropriateness varied strikingly depending on the CPG used. It seems urgent to reduce treatment overuse without neglecting underuse, as is urgent an attempt to reach wider agreement worldwide regarding osteoporosis management, in order to facilitate appropriate treatment and development of policies to reduce effectively treatment inappropriateness.
authors: Health Services Research Unit, Center for Public Health Research (FISABIO), Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Gabriel
authors: G
authors: Sanfélix-Gimeno
authors: Health Services Research Unit, Center for Public Health Research (FISABIO), Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Isabel
authors: I
authors: Hurtado
authors: Health Services Research Unit, Center for Public Health Research (FISABIO), Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Fundación de Investigación del Hospital Clínico Universitario-Instituto de Investigación Sanitaria INCLIVA. Valencia, Spain.
authors: José
authors: J
authors: Sanfélix-Genovés
authors: Health Services Research Unit, Center for Public Health Research (FISABIO), Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Cristóbal
authors: C
authors: Baixauli-Pérez
authors: Health Services Research Unit, Center for Public Health Research (FISABIO), Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Clara L
authors: CL
authors: Rodríguez-Bernal
authors: Health Services Research Unit, Center for Public Health Research (FISABIO), Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Salvador
authors: S
authors: Peiró
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology