title: Comorbidities, bone-sparing agent prescription history and their determinants among postmenopausal women in UK primary care settings: a retrospective database study.
abstract: CONCLUSIONS
  Distinguishing oral bisphosphonates from other bone-sparing therapies, this retrospective observational study, first, characterized treated osteoporosis patients in the UK, and secondly, explored factors associated with the risk of discontinuation or switching between therapies. The latter should be considered when evaluating real-world data.
  
  
  OBJECTIVE
  This retrospective observational study evaluated the characteristics of women with postmenopausal osteoporosis, including comorbidities and determinants of treatment patterns with bone-sparing agents.
  
  
  METHODS
  The UK Clinical Practice Research Datalink was used to identify postmenopausal women (aged ≥50 years) treated with a bone-sparing agent or diagnosed with osteoporosis between 1 January 1993 and 31 December 2008. Two non-mutually-exclusive subpopulations were defined: (1) patients active in the database on 31 December 2008; (2) patients treated with a bone-sparing agent since 1 January 1993. Subpopulation 1 was used to describe patient comorbidities and osteoporosis treatment history, and subpopulation 2 was used to explore the characteristics associated with bone-sparing treatment patterns use via multivariable regression for repeated multinomial responses.
  
  
  RESULTS
  A total of 62,657 individuals met the inclusion criteria; subpopulation 1 comprised 38,469 women (61.4%), of whom 21,687 received a bone-sparing agent in 2008 (99.7% oral bisphosphonates and the remainder other agents). Those receiving other agents were more likely to have had previous treatment with bone-sparing agents, to have experienced previous fractures, and to have visited their doctor more frequently. Analyses also identified several comorbidities associated with an increased risk of discontinuation of bone-sparing agents, including heart disease, gastrointestinal disease, and renal failure. Anticonvulsant use was associated with a dramatic increase in the risk of switching.
  
  
  CONCLUSIONS
  Several patient characteristics were associated with discontinuation of, or switching between, bone-sparing treatments. Patients receiving bone-sparing medication other than oral bisphosphonates were more likely to have comorbid conditions and a history of fracture and to have taken an oral bisphosphonate previously.
authors.affiliation: Amgen Ltd, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK. Maurille@amgen.com.
authors.forename: M
authors.initials: M
authors.lastname: Feudjo-Tepie
authors.affiliation: Amgen Ltd, 240 Cambridge Science Park, Milton Road, Cambridge, CB4 0WD, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ferguson
authors.affiliation: GlaxoSmithKline PLC, Stockley Park West, 1-3 Iron Bridge Road, Uxbridge, Middlesex, UB11 1BT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Roddam
authors.affiliation: Amgen Ltd, 240 Cambridge Science Park, Milton Road, Cambridge, CB4 0WD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Taylor
authors.affiliation: University of Derby, Derby, DE22 1GB, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bayly
authors.affiliation: Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, California, 91320, USA.
authors.forename: C
authors.initials: C
authors.lastname: Critchlow
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015897:Comorbidity; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000453:epidemiology; D017698:Postmenopause; D011320:Primary Health Care; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants; D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bone-sparing agents; Clinical Practice Research Datalink; Comorbidities; Discontinuation; Postmenopausal osteoporosis; Switching