Pharmaceutical treatment of symptomatic vertebral fractures in primary care
- 1York Trials Unit, Department of Health Sciences, York University, York, UK
- 2Eli Lilly Pharmaceuticals, Basingstoke, UK
- 3Kings Road Surgery, Mumbles, Swansea, UK
- 4MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Correspondence to:
Dr David J Torgerson
Department of Health Sciences, University of York, York YO10 5DD; djt6york.ac.uk
- Accepted 14 September 2003
Abstract
Background: Vertebral fractures are associated with a reduction in quality of life and are an important predictor of other non-spine fractures. Previous work has shown that up to 60% of patients with a vertebral fracture identified in primary care remain untreated.
Objective: To examine the prevalence of pharmaceutical treatment and predictors of treatment in a primary care setting.
Methods: Case–control study using the general practice research database (GPRD). All women aged 50 years and over with a first diagnosis of a vertebral fracture since 1990 were identified and matched with a control by age and practice. Appropriate use of a pharmaceutical agent was defined as a prescription occurring within 30 days of the diagnosis being recorded.
Results: We identified 2719 women with the same number of controls. Within 30 days of diagnosis 61% of women were prescribed treatment, compared with only 3% of the controls. Bisphosphonate was the single most important treatment prescribed. Predictors of any drug treatment included: year of fracture (most recent year increased the likelihood of treatment); age (younger patients were more likely to receive treatment); history of back pain; low body weight; history of steroid use.
Conclusions: Treatment of diagnosed vertebral fractures is becoming more common. Treated patients tend to be younger but to have a higher prevalence of clinical risk factors than untreated patients. There remain significant numbers of patients who are not offered treatment.
