Influence of gastrointestinal events on treatment of osteoporosis in Asia-Pacific women: Perspectives from physicians in the MUSIC OS-AP study

Abstract

BackgroundThe objectives of the physician survey component of the MUSIC OS-AP study were to describe physicians' approaches to treatment of women with postmenopausal osteoporosis and to understand the influence of gastrointestinal (GI) events on treatment in clinical practice.MethodsPhysicians were recruited from 5 Asia-Pacific countries. Questionnaires collected information about physicians' standard practices for treatment of patients with osteoporosis, as well as their perspectives on the influence of GI events on osteoporosis treatment approaches.ResultsA total of 59 physicians participated in the study. The most frequently prescribed or recommended treatments were vitamin D (84% of patients), calcium (82%), and oral bisphosphonates (59%). When choosing a medication for treatment-naïve patients, GI sensitivity was often or always a factor for 79% of physicians. Among physicians not prescribing pharmacologic treatment, a mean of 18% of non-prescriptions were due to GI sensitivity. For patients with pre-existing GI conditions, physicians most frequently ranked use of non-oral osteoporosis medication as the first treatment strategy (47%), followed by co-prescription with a proton pump inhibitor or other gastro-protective agent (31%). For patients developing GI symptoms after starting pharmacologic treatment, the most frequently first-ranked management strategy was to check if patients were taking their osteoporosis medication correctly as prescribed (64%), followed by temporary discontinuation of the medication (i.e., a drug holiday) until GI events have resolved (31%) and co-prescription with a proton pump inhibitor or other gastroprotective agent (24%).ConclusionsThese results suggest that GI events influence the prescribing practices of physicians in the Asia-Pacific region and sometimes result in non-treatment of women with osteoporosis.

An Exploration of Current Primary Care Practice Regarding Osteoporosis Assessment Following a Low Trauma Wrist Fracture in people aged 50 years and above in Wellington, New Zealand: A Quantitative Survey

“…There are also well documented adverse effects of anti-osteoporosis medications. Multiple studies both qualitative and quantitative identify the impact of this on whether GP survey respondents are willing to prescribe the medication, and whether patients will commence or continue to take their medication (Alami et al, 2016;Barrionuevo et al, 2019;Modi et al, 2017;Mora et al, 2019;Sale et al, 2011;Swart et al, 2018). The adverse effects of osteoporosis medications have been highlighted as part of collecting Australian and New Zealand Hip Fracture Registry (ANZHFR) data for CCDHB, where local participants describe anti-osteoporosis medication side effects experienced by friends and family as a reason for reluctance to take it themselves.…”

“…were not reported in the published outputs. Multiple research looks at how GP survey respondents carry out their role in osteoporosis assessment and treatment (Alami et al, 2016;Blazkova et al, 2010;Fogelman et al, 2016;Modi et al, 2017;Neuner & Schapira, 2012;Otmar et al, 2012;Swart et al, 2018), and the care gaps within these roles. However, the presumption within the available research is that GP survey respondents are already leading the care for osteoporosis assessment and treatment.…”