A longitudinal retrospective cohort study used MedicineInsight data from Australian general practice patients who presented to their doctor between 2011 and 2018 and were aged over 50 years (n = 203,201).
MedicineInsight is a national general practice data program that extracts longitudinal, de-identified patient data from the clinical information systems (CISs) of participating general practices.
Find out more about MedicineInsight
In depth interviews with a sample of GPs from MedicineInsight practices were also undertaken in this study. The aim was to identify current trends in osteoporosis medicine prescribing and treatment patterns, and to explore GP attitudes and beliefs about osteoporosis management.2
Read the full study: Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice
An upward trend in osteoporosis medicine prescriptions for the patient cohort, from just under 20,000 in 2012 to nearly 35,000 in 2017, was largely due to a progressive increase in the number of denosumab prescriptions combined with a decrease in prescriptions for bisphosphonates and other osteoporosis medicines.2
Despite a steady increase in the total annual number of prescriptions for osteoporosis medicines, almost a quarter of the patients who had a recorded diagnosis of osteoporosis (n = 25,188) did not have any record of a prescription for an osteoporosis medicine.2
Managing osteoporosis medicines
Qualitative interviews with a sample of GPs working in practices across Australia identified gaps in knowledge about how to manage osteoporosis medicines to maximise their effectiveness.
Most GPs were aware of the need to administer denosumab every 6 months for maximum efficacy and that interrupting or stopping denosumab treatment causes rapid reversal of bone mineral density (BMD) gains and increased risk of fracture.2,3,7,8
However, the MedicineInsight data showed that there was insufficient substitution with another osteoporosis medicine when denosumab was ceased in general practice. More than 80% of the patients who had stopped denosumab received no subsequent prescription for a bisphosphonate, potentially exposing them to rapid bone loss.2
Planned breaks (drug holidays) for patients on long-term bisphosphonates who had responded well to treatment was a familiar concept for most GPs. However, some GPs expressed uncertainty about whether drug holidays were appropriate for their patients, how to undertake them and what follow-up was required.2
Attitudes and beliefs
The study revealed GP attitudes or beliefs about osteoporosis treatment.2
- lack of clarity about benefits of initiating osteoporosis treatment to prevent fractures
- reluctance to start treatment where there was no evidence of fracture
- uncertainty about the effects of stopping osteoporosis treatment, especially denosumab
- doubt about the appropriateness of planned breaks from treatment, ie, drug holidays, especially for bisphosphonates
- choosing not to start denosumab if they thought that patients were unlikely to return for a follow-up injection.
Several patient factors potentially affecting osteoporosis management were also identified by GPs.2
- poor patient awareness of osteoporosis and its consequences
- patient scepticism and reluctance to commence or continue treatment, particularly when there were no symptoms or few tangible benefits
- concerns about adverse effects
- complex dosing schedules, particularly with bisphosphonates
- cost of treatment.
This data highlights the need for targeted interventions to help improve knowledge and management of osteoporosis in general practice and to address attitudes and beliefs to improve treatment choices and adherence.
The following practice points can help to optimise osteoporosis treatment and management.