British journal of clinical pharmacology最新文献

{"title":"Therapeutic drug monitoring education: The current state.","authors":"Guenka Petrova, Stiliyana Blagova, Konstantin Tachkov, Marlene Santos, James Bluett, Merita Rumano, Elena Kkolou, Elena Drakalska, Marija Arev, Mehtap Cakmak Barsbay, Denis Mulleman","doi":"10.1002/bcp.70252","DOIUrl":"https://doi.org/10.1002/bcp.70252","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate available information on therapeutic drug monitoring (TDM) education programmes and their implementation across different countries.</p><p><strong>Methods: </strong>The study was performed in two phases. First, a scoping review of scientific literature on available education programmes was performed. Afterwards, a questionnaire was distributed among a worldwide network of professionals engaged in the practice of TDM.</p><p><strong>Results: </strong>Eight scientific articles discussing TDM educational programmes were found. They described in depth an educational programme on TDM, which was primarily offered as postgraduate education programme for hospital staff. We received a total 23 responses (30% response rate); of these, 68% were from academia. For 70% of respondents, TDM is part of the educational programme of healthcare professionals, and for 56% it is offered at both undergraduate and postgraduate level, aimed mainly at physicians (39%) and pharmacists (65%). TDM is mainly performed in infectious diseases (n = 15), neurology (n = 14) and psychiatry (n = 12), as well as for antibiotics (83%), monoclonal antibodies (53%), and oncology and psychotropics (48%). Funding for TDM is derived mostly from public health insurance (48%), hospital (44%), patients (39%). In some cases, patients might co-pay to hospital or to health insurance fund.</p><p><strong>Conclusions: </strong>Education on TDM is scattered across different subjects, disciplines and degrees. It is oriented essentially towards physicians and pharmacists, and its funding is mainly public. General guidelines are lacking. In light of this, it is necessary to consider developing a comprehensive educational programme on TDM, oriented towards relevant drugs and diseases, and encompassing appropriate analytical and pharmacological methods.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide use is associated with neuromuscular junction degradation in older adults with type II diabetes mellitus.","authors":"Rizwan Qaisar, Imran Ullah Khan, Atif Ur Rehman, M Shahid Iqbal, Firdos Ahmad, Asima Karim","doi":"10.1002/bcp.70253","DOIUrl":"https://doi.org/10.1002/bcp.70253","url":null,"abstract":"<p><strong>Aims: </strong>Older men with type 2 diabetes mellitus (T2DM) face a heightened risk of sarcopenia. This study aimed to compare the longitudinal effects of semaglutide, a glucagon-like peptide-1 receptor agonist and sitagliptin as the control group on sarcopenia indicators and biomarkers of neuromuscular junction and neuronal health in patients with T2DM over 1 year.</p><p><strong>Methods: </strong>A cohort of 141 older men with T2DM (semaglutide, n = 68; sitagliptin group, n = 73) underwent assessments at baseline, 6 months and 1 year. Measured parameters included handgrip strength (HGS), gait speed, appendicular skeletal muscle mass index (ASMI), short physical performance battery (SPPB) and plasma concentrations of C-terminal agrin fragment 22 (CAF22), neurofilament light chain (NfL) and brain-derived neurotrophic factor (BDNF).</p><p><strong>Results: </strong>Over the study period, the semaglutide group exhibited significant reductions in HGS, gait speed, ASMI and SPPB scores (all P < .05). Concurrently, this group exhibited more pronounced elevation of plasma CAF22 and NfL levels compared to the sitagliptin group (all P < .05). Among the patients taking semaglutide, higher CAF22 and NfL levels generally correlated with poorer HGS, ASMI and SPPB scores. In contrast, lower BDNF levels were associated with reduced ASMI and SPPB at specific time points (all P < .05). Multiple regression analysis confirmed significant negative associations between CAF22 and NfL, and a positive association between BDNF and sarcopenia parameters, specifically among patients taking semaglutide.</p><p><strong>Conclusions: </strong>Semaglutide treatment in older men with T2DM may be associated with a decline in muscle strength and physical performance, potentially associated with neuromuscular junction degradation and neuronal damage. These findings underscore the importance of closely monitoring musculoskeletal health in patients receiving semaglutide.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness of oxycodone use for acute pain in surgical and obstetric departments using a clinical data warehouse.","authors":"Fabien Xuereb, Kilian Trin, Romain Griffier, Francesco Salvo, Matthieu Frasca, Pernelle Noize, Julien Bezin, Antoine Pariente","doi":"10.1002/bcp.70199","DOIUrl":"https://doi.org/10.1002/bcp.70199","url":null,"abstract":"<p><strong>Aims: </strong>The use of oxycodone, recommended as a second-line treatment after morphine, has risen strongly over the last years. Considering its addictive potential, the aim of this study was to evaluate the appropriateness of use of oxycodone for acute pain.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted using a university hospital clinical data warehouse and included all patients with at least one administration of oxycodone or morphine in surgery and obstetrics wards in 2022. The population was analysed using automatically collected data, and a random 100-patient sample was analysed through an extensive clinical record review.</p><p><strong>Results: </strong>The appropriate use of oxycodone implies four cumulative conditions which are represented by the primary outcomes carried out on the random 100-patient sample. Firstly, 74% of stays received oxycodone not preceded immediately by morphine: 21% had received oxycodone immediately after morphine, but 44% received oxycodone as first strong opioid and 27% received oxycodone combined with morphine as first opioid treatment, with justification found in less than 5%. Secondly, of the 1035 oxycodone administrations recorded in our sample, 398 (38.5%) were immediate-release forms administered for mild pain or without pain assessment. Thirdly, 28% were not combined with any other analgesic (no multimodal analgesia) and 42% were combined with another opioid. Finally, 60.6% were not combined with a laxative.</p><p><strong>Conclusions: </strong>The majority of patients treated with oxycodone in surgery had inappropriate prescribing. Considering the known risk of developing opioid use disorder after a first administration in surgery, important educational effort seems needed.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of interventions for fever-associated discomfort in children: A systematic review.","authors":"Antonio Corsello, Ilaria Alberti, Sara Farhanghi, Alessia Bonetti, Silvia Garattini, Anna Comotti, Paola Marchisio, Elena Chiappini, Gregorio Paolo Milani","doi":"10.1002/bcp.70203","DOIUrl":"https://doi.org/10.1002/bcp.70203","url":null,"abstract":"<p><strong>Aims: </strong>Fever is one of the most frequent reasons for paediatric consultations. While traditionally managed by reducing body temperature, recent guidelines emphasize alleviating discomfort as the primary therapeutic goal. Although different interventions have been described to manage fever-associated discomfort in children, their effectiveness and safety has never been systematically analysed. The aim of this study was to review the evidence on the effectiveness and safety of pharmacological and nonpharmacological interventions for managing discomfort in febrile children.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA guidelines (PROSPERO: CRD420250655721). PubMed, Embase and Cochrane Library were searched up to 31 January 2025, for studies involving children aged 29 days to 18 years that assessed interventions for fever-associated discomfort. Randomized controlled trials and observational studies were included. Risk of bias was assessed using Cochrane and STROBE tools. Results were synthesized narratively and grouped according to the type of intervention.</p><p><strong>Results: </strong>Eight studies (5 randomized controlled trials, 3 observational) involving 1877 children were included. Study designs, including dosage of antipyretics and quality varied across studies. Studies comparing ibuprofen and paracetamol provided conflicting results, while combination therapy (paracetamol + ibuprofen) appeared more effective than using a single drug in -one trial. Tepid sponging, despite reducing temperature, was associated with increased discomfort. No serious adverse events were reported.</p><p><strong>Conclusion: </strong>Pharmacological treatments appear effective and safe, whereas physical methods offer limited benefit. The available evidence is limited by the small number of studies, methodological heterogeneity, and concerns about risk of bias and outcome measurement inconsistency. New high-quality studies are needed to guide clinical practice for the management of fever-associated discomfort in children.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dolutegravir with enteral feeds in intensive care: Case series with therapeutic drug monitoring.","authors":"Suki Leung, Adam Temple, Yaser Al-Shakarchi, Silma Shah, Nadia Naous, Alessia Dalla Pria, Borja Mora Peris, Mark Nelson, Marta Boffito, Margherita Bracchi","doi":"10.1002/bcp.70260","DOIUrl":"10.1002/bcp.70260","url":null,"abstract":"<p><p>People with HIV admitted to the intensive care unit (ITU) often receive enteral nutrition via feeding tubes. Enteral feeds containing cations may interfere with dolutegravir (DTG) absorption via chelation and thus temporal spacing is recommended. This can lead to suboptimal caloric intake. We reviewed similar cases at our institution, an electronic health record and data collection, including people with HIV hospitalized in ITU with enterally administered DTG and therapeutic drug monitoring (TDM). Six cases (four males, two females, median age 34 years, median ITU admission 44.5 days, median 42.5 days on enteral nutrition) were identified with eight data points of TDM sampling. In three of eight instances, appropriate temporal spacing with enteral feeds occurred. All DTG C_max (maximum concentrations) were lower than 3340-3670 ng/mL, regardless of temporal separation from enteral feeds. C_trough (trough plasma concentrations) were also lower than 830-1110 ng/mL with the exception of one case. Six of eight C_trough were lower than the DTG minimum effective concentration (MEC) of 300 ng/mL. However, only one was below PA-IC₉₀ (in vitro protein-adjusted 90% maximal inhibitory concentration) for wildtype virus (64 ng/mL). Multiple factors such as delayed gastric emptying and changes in gastric pH are likely contributing to impaired drug absorption and reduced DTG concentrations in critically ill patients. The data on nutritional feed co-administration demonstrate that therapeutic concentrations and virological responses can be achieved with frequent viral load (VL) monitoring and TDM. Further pharmacokinetic studies on DTG in critically ill patients are warranted to better understand the impact of this co-administration.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pharmacist-led costs optimization in ischaemic stroke care: A diagnosis-related groups-based intervention study.","authors":"Yun Li, Xianlin Li, Haitao Guo, Jin Zhang, Xiaojun Zheng","doi":"10.1002/bcp.70246","DOIUrl":"https://doi.org/10.1002/bcp.70246","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the impact of clinical pharmacists' intervention on drug cost optimization for ischaemic stroke inpatients under the diagnosis-related groups (DRGs) payment model.</p><p><strong>Methods: </strong>This study collected hospitalization data of patients with ischaemic stroke in the BR23 disease group from the neurology department between June 2023 and July 2024. The dataset was divided into a control group (no pharmacist intervention) and an experimental group (pharmacist intervention). Using t-tests, chi-square tests and Mann-Whitney U tests, this study analysed the changing trends in hospitalization costs for ischaemic stroke patients after pharmacists participated in clinical pharmacy pathways under the DRG model. The analysis included demographic characteristics, comorbidities, length of hospitalization, incidence of adverse drug reactions, irrational medication use rates, total hospitalization costs, total drug costs and costs of key monitoring drugs between the 2 groups.</p><p><strong>Results: </strong>There were no significant differences in age, sex, or comorbidities. Length of hospitalization and incidence of adverse drug reactions did not differ significantly (P > .05), but irrational medication use was lower in the experimental group (P < .05). Compared to the control group, the experimental group had significantly lower total hospitalization costs, total drug costs and costs of key monitoring drugs (P < .05), along with clear improvements in cost control and excess payment management.</p><p><strong>Conclusions: </strong>This study demonstrates that pharmacist involvement in clinical pathways under the DRGs payment model effectively reduces drug costs for hospitalized ischaemic stroke patients while ensuring clinical efficacy and safety, highlighting the role of pharmacists in cost control.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using non-linear slide decks to administer individualized problem-based learning assessments within pharmacology education.","authors":"Wendy R Francis, Nia A Davies, Aidan Seeley","doi":"10.1002/bcp.70248","DOIUrl":"https://doi.org/10.1002/bcp.70248","url":null,"abstract":"<p><strong>Aim: </strong>Problem-based learning (PBL) is an established approach in medical, nursing, pharmacy and veterinary medicine education. This study describes the implementation and aims to evaluate the use of non-linear slide decks as a method to deliver PBL as individualized student assessments within pharmacology education. This approach, originally developed in response to the COVID-19 pandemic, has been evaluated over 5 years since its integration within undergraduate pharmacology modules.</p><p><strong>Methods: </strong>Two non-linear slide decks were designed using Microsoft PowerPoint with interactive hyperlink navigation, allowing dynamic and student-directed progression through two scenarios: a summative clinical toxicology assessment and a formative pharmacokinetic calculation activity.</p><p><strong>Results: </strong>Comparative analysis of student performance demonstrated that grades achieved via non-linear PBL (67.6 ± 10.4%, n = 140) were comparable to those from essays (65.3 ± 12.7%, n = 83) and oral presentations (66.0 ± 6.5%, n = 56), though lower than online quizzes (71.4 ± 11.3%, n = 141). Furthermore, student feedback (n = 31) demonstrated positive student perceptions of non-linear PBL.</p><p><strong>Conclusion: </strong>Despite the increased complexity involved in developing and integrating non-linear PBL resources, this methodology offers an engaging, flexible and pedagogically robust strategy that promotes active learning. It addresses long-standing challenges associated with group-based PBL formats while meeting recommended pharmacology education curricula.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of pharmacist care on hospitalizations in heart failure across outpatient and inpatient settings: A systematic review and meta-analysis.","authors":"Lorenz Van der Linden, Craig Beavers, Paul Forsyth, Christophe Vandenbriele, Ross T Tsuyuki, Fatma Karapinar-Carkıt, Lucas Van Aelst","doi":"10.1002/bcp.70261","DOIUrl":"https://doi.org/10.1002/bcp.70261","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) is major cause of unplanned (re)hospitalizations, especially in high-risk patients such as those recently discharged or those with worsening HF. Hospital-affiliated or clinic-based pharmacists, though underutilized, may help reduce this burden. This systematic review and meta-analysis assessed their impact on all-cause and HF hospitalizations.</p><p><strong>Methods: </strong>A systematic literature search using PUBMED and EMBASE and conducted according to PRISMA guidelines identified randomized controlled trials published up to November 2024. Eligible studies evaluated the effects of pharmacy interventions on hospitalizations and mortality among patients with HF. Studies with community pharmacy- or home-based interventions were excluded. Study quality was appraised using the Cochrane risk-of-bias tool. Random-effects models were applied to derive odds ratios (OR), with heterogeneity assessed using the I² statistic and Cochrane's Q test.</p><p><strong>Results: </strong>Eleven studies were included, involving 3576 patients and a variety of pharmacist interventions. Pharmacists significantly reduced the odds of all-cause hospitalizations compared to usual care (3472 patients, 927 events; OR 0.67, 95% confidence interval [CI]: 0.49-0.92, P = 0.0119). For HF hospitalizations (3442 patients, 504 events), similar results were retrieved (OR 0.64, 95% CI: 0.48-0.87, P = 0.0038). Heterogeneity was moderate for both analyses. Sensitivity analyses supported the robustness of these two analyses. Subgroup analyses indicated greater effectiveness in outpatient settings and when extended interventions were provided.</p><p><strong>Conclusions: </strong>Across inpatient and outpatient settings, pharmacist interventions in HF significantly reduced all-cause as well as HF hospitalizations. Our findings highlight the importance of integrating pharmacists into multidisciplinary teams to improve HF management for in- and outpatients.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the efficacy of efgartigimod and intravenous immunoglobulin on AQP4‐IgG‐positive neuromyelitis optica spectrum disorder during acute attacks","authors":"Jia Liu, Min Li, Haotian Wu, Xiaofeng Xu, Kai Dai, Ruiqi Dong, Junyu Liu, Lu Yang, Ying Jiang, Fuhua Peng","doi":"10.1002/bcp.70190","DOIUrl":"10.1002/bcp.70190","url":null,"abstract":"<p><strong>Aims: </strong>The aim of our study was to evaluate the efficacy of efgartigimod and intravenous immunoglobulin (IVIG) on AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) patients during acute attacks.</p><p><strong>Methods: </strong>A retrospective case-control study was designed to compare the clinical outcomes of 13 NMOSD patients treated with efgartigimod (at a dose of 20 mg/kg in the first and fifth day) and 20 NMOSD patients treated with IVIG (at 0.4 g/kg/day for 5 days). Follow-up outcome information for patients is documented at 6 months postdischarge.</p><p><strong>Results: </strong>Compared with IVIG, efgartigimod could improve NMOSD patients' symptoms during acute attacks, the mean Expanded Disability Status Scale score was significantly improved from 3.0 at admission to 2.5 at discharge (P < .001). The serum IgG levels were obviously decreased in NMOSD patients treated with efgartigimod (P < .001). Additionally, AQP4-IgG titres in 5 NMOSD patients were found to turn negative after efgartigimod treatment.</p><p><strong>Conclusion: </strong>The efficacy of efgartigimod is comparable to IVIG therapy in improving acute symptoms of AQP4-IgG-positive NMOSD. Efgartigimod could be an elegant alternative to IVIG therapy, and no serious adverse events were observed during infusion.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the impact of multimorbidity, medications and frailty on zoledronic acid efficacy in treating osteoporosis among older adults.","authors":"Bersan Ozcan, Serdar Ceylan, Munevver Ozcan, Merve Guner, Cafer Balcı, Mustafa Cankurtaran, Meltem Halil, Burcu Balam Dogu","doi":"10.1002/bcp.70243","DOIUrl":"https://doi.org/10.1002/bcp.70243","url":null,"abstract":"<p><strong>Aims: </strong>This study investigates the interplay between drug effects, multimorbidity, frailty and comprehensive geriatric evaluation on zoledronic acid (ZA) treatment success in osteoporosis (OP), particularly among frail, older adults, a group often excluded from research.</p><p><strong>Methods: </strong>In this retrospective cohort study, a retrospective analysis of 156 OP-treatment-naïve geriatric outpatients who received their first ZA treatment was conducted. Bone mineral density (BMD) and T-scores in the lumbar, femoral neck and total femur regions were assessed using dual-energy X-ray absorptiometry and patients' fall history was assessed. BMD decrease exceeding the LSC was considered sufficient to define treatment failure, alongside the occurrence of two or more new fragility fractures.</p><p><strong>Results: </strong>In a predominantly female cohort (76%) with a median age of 75 years, 23.1% experienced frailty and 17.3% had malnutrition, yet most remained independent and cognitively intact. Over a median follow-up of 14.4 months, significant improvements in BMD and reduced fragility fractures were observed, with 70.5% responding successfully to treatment. Univariate analysis identified advanced age, prolonged dosing intervals, illiteracy, multimorbidity, polypharmacy and diabetes mellitus as factors that reduced treatment efficacy. Regression analysis supported these findings, highlighting the complexities of managing OP in older adults.</p><p><strong>Conclusions: </strong>The study emphasizes that identifying barriers to treatment success is crucial for optimizing OP management. ZA improves BMD and reduces fractures, even in frail older adults with multimorbidity, supporting its use across diverse patient profiles and stressing the need for personalized treatment strategies.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}