Prescribing for osteoporosis following the use of inhaled and oral corticosteroids in general practice

David Williams, Kenneth Arthur Bennett, J. Feely

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aims

Systemic absorption from inhaled glucocorticoids may lead to bone loss. We determined the extent to which their use alone and in addition to short courses of oral glucocorticoids was associated with increased prescribing for osteoporosis in a large general practice population.

Methods

In a cohort study with follow-up of co-prescribing of antiosteoporotic drug therapy in the Irish national prescribing database (1.1 million people over 16 years), we identified 32 081 patients who received inhaled glucocorticoids alone during a 12-month period (following an identical lead-in period). We determined the odds ratio (OR), adjusting for age and gender for the co-prescription of bisphosphonates or other antiosteoporotic therapy with inhaled glucocorticoids by logistic regression.

Results

The adjusted OR (95% confidence interval) for co-prescribing of bisphosphonates and all inhaled glucocorticoids was 1.87 (1.71, 2.04); 1.58 (1.41, 1.78) for inhaled beclomethasone, 2.11 (1.75, 2.54) for inhaled budesonide and 3.29 (2.65, 4.1) for inhaled fluticasone. The ORs were significantly increased when patients who also received oral glucocorticoids were included and greater still in those under 45 years: 14.03 (10.6, 18.6). The results remained significant when the effects of comorbidity were adjusted for. The odds of receiving bisphosphonate therapy increased linearly with increasing exposure to inhaled glucocorticoids during the study period.

Conclusions

Treatment with inhaled glucocorticoids in general practice is associated with an increased risk of co-prescribing for antiosteoporotic therapy in a potency- and a dose-related manner. Exposure to a course of oral glucocorticoids doubles this risk. These results suggest that the systemic effects on bone mineral density from using inhaled glucocorticoids may be clinically relevant but may also reflect prescribers' concerns for the development of osteoporosis in these patients.

Original languageEnglish
Pages (from-to)665-672
Number of pages7
JournalBritish Journal of Clinical Pharmacology
Volume58
Issue number6
DOIs
Publication statusPublished - 2004

Keywords

  • general practice
  • inhaled corticosteroids
  • oral glucocorticoids
  • osteoporosis
  • BONE-MINERAL DENSITY
  • RHEUMATOID-ARTHRITIS
  • CORTICOSTEROIDS
  • ASTHMA
  • RISK

Cite this

Prescribing for osteoporosis following the use of inhaled and oral corticosteroids in general practice. / Williams, David; Bennett, Kenneth Arthur; Feely, J.

In: British Journal of Clinical Pharmacology, Vol. 58, No. 6, 2004, p. 665-672.

Research output: Contribution to journalArticle

Williams, David ; Bennett, Kenneth Arthur ; Feely, J. / Prescribing for osteoporosis following the use of inhaled and oral corticosteroids in general practice. In: British Journal of Clinical Pharmacology. 2004 ; Vol. 58, No. 6. pp. 665-672.
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abstract = "AimsSystemic absorption from inhaled glucocorticoids may lead to bone loss. We determined the extent to which their use alone and in addition to short courses of oral glucocorticoids was associated with increased prescribing for osteoporosis in a large general practice population.MethodsIn a cohort study with follow-up of co-prescribing of antiosteoporotic drug therapy in the Irish national prescribing database (1.1 million people over 16 years), we identified 32 081 patients who received inhaled glucocorticoids alone during a 12-month period (following an identical lead-in period). We determined the odds ratio (OR), adjusting for age and gender for the co-prescription of bisphosphonates or other antiosteoporotic therapy with inhaled glucocorticoids by logistic regression.ResultsThe adjusted OR (95{\%} confidence interval) for co-prescribing of bisphosphonates and all inhaled glucocorticoids was 1.87 (1.71, 2.04); 1.58 (1.41, 1.78) for inhaled beclomethasone, 2.11 (1.75, 2.54) for inhaled budesonide and 3.29 (2.65, 4.1) for inhaled fluticasone. The ORs were significantly increased when patients who also received oral glucocorticoids were included and greater still in those under 45 years: 14.03 (10.6, 18.6). The results remained significant when the effects of comorbidity were adjusted for. The odds of receiving bisphosphonate therapy increased linearly with increasing exposure to inhaled glucocorticoids during the study period.ConclusionsTreatment with inhaled glucocorticoids in general practice is associated with an increased risk of co-prescribing for antiosteoporotic therapy in a potency- and a dose-related manner. Exposure to a course of oral glucocorticoids doubles this risk. These results suggest that the systemic effects on bone mineral density from using inhaled glucocorticoids may be clinically relevant but may also reflect prescribers' concerns for the development of osteoporosis in these patients.",
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T1 - Prescribing for osteoporosis following the use of inhaled and oral corticosteroids in general practice

AU - Williams, David

AU - Bennett, Kenneth Arthur

AU - Feely, J.

PY - 2004

Y1 - 2004

N2 - AimsSystemic absorption from inhaled glucocorticoids may lead to bone loss. We determined the extent to which their use alone and in addition to short courses of oral glucocorticoids was associated with increased prescribing for osteoporosis in a large general practice population.MethodsIn a cohort study with follow-up of co-prescribing of antiosteoporotic drug therapy in the Irish national prescribing database (1.1 million people over 16 years), we identified 32 081 patients who received inhaled glucocorticoids alone during a 12-month period (following an identical lead-in period). We determined the odds ratio (OR), adjusting for age and gender for the co-prescription of bisphosphonates or other antiosteoporotic therapy with inhaled glucocorticoids by logistic regression.ResultsThe adjusted OR (95% confidence interval) for co-prescribing of bisphosphonates and all inhaled glucocorticoids was 1.87 (1.71, 2.04); 1.58 (1.41, 1.78) for inhaled beclomethasone, 2.11 (1.75, 2.54) for inhaled budesonide and 3.29 (2.65, 4.1) for inhaled fluticasone. The ORs were significantly increased when patients who also received oral glucocorticoids were included and greater still in those under 45 years: 14.03 (10.6, 18.6). The results remained significant when the effects of comorbidity were adjusted for. The odds of receiving bisphosphonate therapy increased linearly with increasing exposure to inhaled glucocorticoids during the study period.ConclusionsTreatment with inhaled glucocorticoids in general practice is associated with an increased risk of co-prescribing for antiosteoporotic therapy in a potency- and a dose-related manner. Exposure to a course of oral glucocorticoids doubles this risk. These results suggest that the systemic effects on bone mineral density from using inhaled glucocorticoids may be clinically relevant but may also reflect prescribers' concerns for the development of osteoporosis in these patients.

AB - AimsSystemic absorption from inhaled glucocorticoids may lead to bone loss. We determined the extent to which their use alone and in addition to short courses of oral glucocorticoids was associated with increased prescribing for osteoporosis in a large general practice population.MethodsIn a cohort study with follow-up of co-prescribing of antiosteoporotic drug therapy in the Irish national prescribing database (1.1 million people over 16 years), we identified 32 081 patients who received inhaled glucocorticoids alone during a 12-month period (following an identical lead-in period). We determined the odds ratio (OR), adjusting for age and gender for the co-prescription of bisphosphonates or other antiosteoporotic therapy with inhaled glucocorticoids by logistic regression.ResultsThe adjusted OR (95% confidence interval) for co-prescribing of bisphosphonates and all inhaled glucocorticoids was 1.87 (1.71, 2.04); 1.58 (1.41, 1.78) for inhaled beclomethasone, 2.11 (1.75, 2.54) for inhaled budesonide and 3.29 (2.65, 4.1) for inhaled fluticasone. The ORs were significantly increased when patients who also received oral glucocorticoids were included and greater still in those under 45 years: 14.03 (10.6, 18.6). The results remained significant when the effects of comorbidity were adjusted for. The odds of receiving bisphosphonate therapy increased linearly with increasing exposure to inhaled glucocorticoids during the study period.ConclusionsTreatment with inhaled glucocorticoids in general practice is associated with an increased risk of co-prescribing for antiosteoporotic therapy in a potency- and a dose-related manner. Exposure to a course of oral glucocorticoids doubles this risk. These results suggest that the systemic effects on bone mineral density from using inhaled glucocorticoids may be clinically relevant but may also reflect prescribers' concerns for the development of osteoporosis in these patients.

KW - general practice

KW - inhaled corticosteroids

KW - oral glucocorticoids

KW - osteoporosis

KW - BONE-MINERAL DENSITY

KW - RHEUMATOID-ARTHRITIS

KW - CORTICOSTEROIDS

KW - ASTHMA

KW - RISK

U2 - 10.1111/j.1365-2125.2004.02218.x

DO - 10.1111/j.1365-2125.2004.02218.x

M3 - Article

VL - 58

SP - 665

EP - 672

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 6

ER -