title: Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: Variation by age, sex, geographic location and ethnicity.
abstract: Given the expected increase in the number of patients with osteoporosis and fragility fractures it is important to have concise information on trends in prescription rates of anti-osteoporosis drugs (AOD).
  
  
  
  We undertook a retrospective observational study using the UK Clinical Practice Research Datalink (CPRD) in the UK between 1990 and 2012 in subjects 50years or older, stratified by age, sex, geographic region and ethnicity. Yearly prescription incidence rates of any AOD and of each specific AOD were calculated as the number of patients first prescribed these AODs per 10,000person-years (py).
  
  
  
  In women, yearly rates of first prescription of any AOD increased from 1990 to 2006 (from 2.3 to 169.7 per 10,000py), followed by a plateau and a 12% decrease in the last three years. In men, a less steep increase from 1990 to 2007 (from 1.4 to 45.3 per 10,000py) was followed by a plateau from 2008 onwards. Yearly rates of first prescription of any AOD increased up to the age of 85-89years (248.9 per 10,000py in women and 119.3 in men). There were marked differences between ethnic groups and regions. Bisphosphonates were the most frequently prescribed AODs: etidronate till 2000, and then subsequently alendronate.
  
  
  
  We have demonstrated marked secular changes in rates of anti-osteoporosis drug prescription over the last two decades. The plateau (and decrease amongst women) in rates in recent years, set against an ever ageing population, is worrying, suggesting that the well-documented care gap in osteoporosis treatment persists. The differences in prescription rates by geographic location and ethnicity raise intriguing questions in relation to underlying fracture rates, provision of care and health behaviour.
  
  
  
  We studied the prescription incidence of anti-osteoporosis drugs (AOD) from 1990 to 2012 in the UK CPRD. Overall AOD prescription incidence showed a strong increase from 1990 to 2006, followed by a plateau in both sexes and a decrease amongst women in the last three years.
authors.affiliation: Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands; Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: R Y
authors.initials: RY
authors.lastname: van der Velde
authors.affiliation: Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands; Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Wyers
authors.affiliation: Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Teesselink
authors.affiliation: Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands; Biomedical Research Centre, Hasselt University, Agoralaan - gebouw D, 3590 Diepenbeek, Belgium.
authors.forename: P P M M
authors.initials: PPMM
authors.lastname: Geusens
authors.affiliation: Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX Venlo, The Netherlands; Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD Maastricht, The Netherlands; Biomedical Research Centre, Hasselt University, Agoralaan - gebouw D, 3590 Diepenbeek, Belgium.
authors.forename: J P W
authors.initials: JPW
authors.lastname: van den Bergh
authors.affiliation: Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: de Vries
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK. Electronic address: cc@mrc.soton.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: Health eResearch Centre, University of Manchester, Manchester, UK; Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht 3508 TB, The Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: van Staa
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology*; D012727:Sex Characteristics; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents
keywords: AOD; Anti-osteoporosis drugs; Epidemiology; Fracture; Osteoporosis; Secular trends