Advertisement
Research Article| Volume 74, ISSUE 1, P74-78, January 2013

Trends in the pharmacological treatment of osteoporosis in Spain from 2000 to 2008

      Abstract

      Aim

      To analyze the time trends in anti-osteoporosis medications consumption in Spain between 2000 and 2008 and the influence on such consumption induced by the Information Sheets related to the safety of menopausal hormone therapy and strontium ranelate published by the Spanish Agency of Medicines and Health Products (AEMPS).

      Methods

      Purchase data of anti-osteoporosis medications from 2000 to 2008 were obtained from the Spanish Ministry of Health. This information includes the pharmacy sales data of medicinal products reimbursed by the Spanish National Health Service. Anti-osteoporosis medications consumption data were expressed as defined daily dose per 1 000 inhabitants per day in women aged 50 or more.

      Results

      During the study period, anti-osteoporosis medications consumption showed a continuous increase. The greatest increase was observed with bisphosphonates, particularly alendronate and risedronate in their weekly formulations. Strontium ranelate consumption was low but continuously increased and new information concerning its safety in 2007 had no effect on its consumption. The use of menopausal hormone therapy remained stable until 2003, and from then presented a continuous decrease until 2008. Raloxifene utilization increased from 2000 to 2004 and decreased thereafter. Calcitonin utilization decreased uninterruptedly and teriparatide was infrequently used.

      Conclusion

      This study reports a marked change in osteoporosis treatment in Spain, which includes an important increase in anti-osteoporosis medication use, particularly of bisphosphonates and a decrease in menopausal hormone therapy use secondary to the new information about their safety.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy
        Osteoporosis prevention, diagnosis, and therapy.
        Journal of the American Medical Association. 2001; 285: 785-795
        • Woolf A.D.
        • Pfleger B.
        Burden of major musculoskeletal conditions.
        Bulletin of the World Health Organization. 2003; 81: 646-656
        • Kanis J.A.
        • Johnell O.
        • De Laet C.
        • Jonsson B.
        • Oden A.
        • Ogelsby A.K.
        International variations in hip fracture probabilities: implications for risk assessment.
        Journal of Bone and Mineral Research. 2002; 17: 1237-1244
      1. FRAX: WHO Fracture Risk Assesment Tool. University of Sheffield. Available on: http://www.shef.ac.uk/FRAX/index.jsp [accessed 15.02.12]

        • Roy D.K.
        • O’Neill T.W.
        • Finn J.D.
        • et al.
        Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS).
        Osteoporosis International. 2003; 14: 19-26
      2. Spanish Agency of Medicines and Health Products. Strontium Ranelate (Protelos, Osseor): risk of severe hypersensitivity adverse reactions. Information Sheet Ref: 2007/17. Available on: http://www.aemps.gob.es/informa/notasInformativas/medicamentosUsoHumano/seguridad/2007/docs/NI_2007-17_protelos-osseor.pdf [accessed 15.02.12]

        • Rossouw J.E.
        • Anderson G.L.
        • Prentice R.L.
        • et al.
        Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial.
        Journal of the American Medical Association. 2002; 288: 321-323
        • Beral V.
        Million Women Study Collaborators, Breast cancer and hormone-replacement therapy in the Million Women Study.
        Lancet. 2003; 362: 419-427
      3. Spanish Agency of Medicines and Health Products. Risks and benefits of hormone therapy replacement with oestrogens associated with progestagens: new data. Information Sheet Ref: 2002/07. Available on: http://www.aemps.gob.es/informa/notasInformativas/medicamentosUsoHumano/seguridad/2002/docs/THS-estrogenos-progestagenos_PS.pdf [accessed 15.02.12]

      4. Spanish Agency of Medicines and Health Products. Restriction of the therapeutic indications to hormone replacement treatment. Information Sheet Ref: 2004/01. Available on: http://www.aemps.gob.es/informa/notasInformativas/medicamentosUsoHumano/seguridad/2004/docs/NI_2004-01_THS_restriccion.pdf [accessed 15.02.12]

      5. Spanish Agency of Medicines and Health Products. Hormonal therapy on menopause: update information. Information Sheet Ref: 2008/16. Available on: http://www.aemps.gob.es/informa/notasInformativas/medicamentosUsoHumano/seguridad/2008/NI_2008-16_terapia_hormonal.htm [accessed 15.02.12]

        • Qaseem A.
        • Snow V.
        • Shekelle P.
        • et al.
        Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians.
        Annals of Internal Medicine. 2008; 149: 404-415
      6. Working Group of the Clinical Practice Guideline on Prevention of Osteoporosis and fragility fractures. Clinical Practice Guideline on Prevention of Osteoporosis and fragility fractures. Quality Plan for the National Health System of the Ministry of Health, Social Policy and Equality. Agència d’Informació, Avaluació i Qualitat en Salut (AIAQS) de Cataluña; 2010. Guide of Clinical Practice of the National Health Service: AATRM N 2007/02. Available on: http://www.gencat.cat/salut/depsan/units/aatrm/pdf/gpc_osteoporosi_aatrm2010_vcompleta.pdf [accessed 15.02.12]

      7. Centre of online Information of Medicines, CIMA. Spanish Agency of Medicines and Health Products. Available on: http://www.aemps.gob.es/ [accessed 15.02.12]

      8. WHO Collaborating Centre for Drug Statistics Methodology. Available on: http://www.whocc.no/atc_ddd_index/ [accessed 15.02.12]

        • Pérez J.
        • Marín N.
        • Vallano A.
        • Castells X.
        • Capellà D.
        Consumption and cost of antipsychotic drugs.
        Actas Espanolas de Psiquiatria. 2005; 33: 110-116
        • Stafford R.S.
        • Drieling R.L.
        • Hersh A.L.
        National trends in osteoporosis visits and osteoporosis treatment, 1988–2003.
        Archives of Internal Medicine. 2004; 164: 1525-1530
        • Guay M.P.
        • Dragomir A.
        • Pilon D.
        • Moride Y.
        • Perreault S.
        Changes in pattern of use, clinical characteristics and persistence rate of hormone replacement therapy among postmenopausal women after the WHI publication.
        Pharmacoepidemiology and Drug Safety. 2007; 16: 17-27
        • Løkkegaard E.
        • Lidegaard O.
        • Møller L.N.
        • Agger C.
        • Andreasen A.H.
        • Jorgensen T.
        Hormone replacement therapy in Denmark, 1995–2004.
        Acta Obstetricia et Gynecologica Scandinavica. 2007; 86: 1342-1351
        • Farley J.F.
        • Blalock S.J.
        • Cline R.R.
        Effect of the women's health initiative on prescription anti-osteoporosis medication utilization.
        Osteoporosis International. 2008; 19: 1603-1612
        • Barrett-Connor E.
        • Mosca L.
        • Collins P.
        • et al.
        Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.
        New England Journal of Medicine. 2006; 355: 125-137
        • Kanis J.A.
        • McCloskey E.V.
        • Jonsson B.
        • Cooper A.
        • Ström O.
        • Borgström F.
        An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women.
        Arch Osteoporos. 2010; 5: 19-48
        • Rocha O.
        • Lunet N.
        • Costa L.
        • Barros H.
        Osteoporosis treatment in Portugal: trends and geographical variation.
        Acta Medica Portuguesa. 2006; 19: 373-380
        • Jonville-Béra A.P.
        • Crickx B.
        • Aaron L.
        • Hartingh I.
        • Autret-Leca E.
        Strontium ranelate-induced DRESS syndrome: first two case reports.
        Allergy. 2009; 64: 658-659
        • Carracedo-Martínez E.
        • Pía-Morandeira A.
        Impact of a health safety warning on strontium ranelate utilization.
        Gaceta Sanitaria. 2010; 24: 151-153
        • Martín Arias L.H.
        • Treceño C.
        • García-Ortega P.
        • et al.
        Hip fracture rates and bisphosphonate consumption in Spain. An ecologic study.
        European Journal of Clinical Pharmacology. 2012; https://doi.org/10.1007/s00228-012-1337-z
        • Hollingworth S.A.
        • Gunanti I.
        • Nissen L.M.
        • Duncan E.L.
        Secondary prevention of osteoporosis in Australia: analysis of government-dispensed prescription data.
        Drugs and Aging. 2010; 27: 255-264
      9. Spanish Agency of Medicines and Health Products. Recommendations for the prevention of jaw osteonecrosis associated with bisphosphonate therapy. Information Sheet Ref: 2009/10. Available on: http://www.aemps.gob.es/informa/notasInformativas/medicamentosUsoHumano/seguridad/2009/docs/NI_2009-10_bisfosfonatos.pdf [accessed 06.06.12]

        • Spanish Health Ministry
        ATC subgroups and drugs of high consumption in the National Health System in 2009.
        Información Terapeútica del Sistema Nacional de Salud. 2010; 34 (Available on: http://www.msc.es/biblioPublic/publicaciones/recursos_propios/infMedic/docs/vol34n3SubgrATCppiosActivos.pdf [accessed 06.06.12]): 89-92
        • Spanish Health Ministry
        ATC subgroups and drugs of high consumption in the National Health System in 2010.
        Información Terapeútica del Sistema Nacional de Salud. 2011; 35 (Available on: http://www.msc.es/biblioPublic/publicaciones/recursos_propios/infMedic/docs/SubgruposATCvol35n4.pdf [accessed 06.06.12]): 124-128
      10. Spanish Agency of Medicines and Health Products. Bisphosphonates and fracture risk atypical femur. Information Sheet Ref: 2011/04. Available on: http://www.aemps.gob.es/informa/notasInformativas/medicamentosUsoHumano/seguridad/2011/docs/NI-MUH_04-2011.pdf [accessed 06.06.12]