Consumidores, prescripción y prescriptores de fármacos para la osteoporosis

Objective

To determine the characteristics of prescribers and consumers of osteoporosis drugs.

Design

Cross-sectional study.

Setting

34 primary care areas for the county of West Gipuzkoa (Spain).

Participants

People older than 13 years, randomly selected from 1673 persons consuming osteoporosis drugs for 1 year.

Intervention

A questionnaire completed through clinical interview and data from the medical record.

Main measurements

Risk factors, drugs, bone mineral density (BMD), prescribers, fracture risk.

Results

We studied 512 persons (90.6% women), with a mean age of 68.9 years, taking 898 drugs for osteoporosis. A total of 24.6% had a history of fracture before the age of 50 years and 21.5% of women were fertile for less than 30 years. BMD was available in 50.4%; of these, 52.8% were osteoporotic. One in three BMD scans performed were not justified. The most widely prescribed drug was calcium, with or without vitamin D (53.4%), followed by biphosphonates (33.95%). Prescriptions were issued by rheumatologists (29.2%), traumatologists, gynecologists and primary care physicians (12.4%). One-third (30.6%) were not based on the best evidence. According to the Black scale, 23.8 ± 3.9% had a high risk of fracture (37.8% primary care, 0% gynecology).

Conclusions

Osteoporosis drugs are being used when not warranted by BMD, risk factors or fracture risk. Specialists prescribe these drugs as much or more than primary care physicians. Standardization of criteria for the rational management of this disease is imperative.