Osteoporosis Prevention in Inhaled Cortico -steroid Users
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Osteoporosis Prevention in Inhaled Cortico-steroid Users
Principle Investigators: Hoan Linh Banh, Pharm.D Andrew Cave, MBChB MClSc Valerie Chan, BScPharm
ACFP:ASA Banff Feb27th 2014
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Conflicts of InterestDr Banh and Ms Chan have no
conflicts to declareDr Cave has received research
support from GSK, Astra-Zeneca, Novartis. Merck Canada, Grifols, Boeringer-Ingelheim but has no conflict related to this study
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IntroductionInhaled corticosteroids (ICS):
◦standard maintenance therapy in controlling symptoms in asthma patients
◦and add on in moderate to severe chronic obstructive pulmonary disease (COPD)
Risk of osteoporosis with systemic corticosteroid use is well known but there is low awareness of risk with ICS
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GINA GuidelinesPatients on (1) High doses ICS (defined as >2 mg beclomethason/day) OR (2) Oral glucocorticosteroids (any dose)
are considered at risk of developing osteoporosis and fractures.
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Osteoporosis PreventionCalcium supplementation
◦Age 19-50: 1000 mg/day◦Age >50: 1200 mg/day
Vitamin D supplementation◦Age <50: 400 IU/day ◦Age >50: 800-2000 IU/day
Lifestyle Modifications◦Smoking Cessation◦Exercise◦Limit alcohol intake
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ObjectivesPrimary: To investigate the extent of
osteoporosis prevention or treatment received by patients with asthma and COPD treated with ICS.
Secondary: To assess the number of patients, regardless of ICS dose, who met the requirements for an initial BMD scan, received the BMD and received appropriate follow up when indicated.
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MethodologyInclusion:
◦Age ≥19 years◦ICS use ≥ 3 months in the past 12
months◦Willing to answer a questionnaire
Exclusion:◦Difficulty speaking English or cognitively
impaired
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Results
- N = 255- Overall mean age = 60 years (SD = 17.4 years)- 66% Female – mean age 61 (SD = 17.1 years)- 34% Male – mean age 57 (SD = 17.7 years)
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Results
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Results
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Results
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Results
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Results
> or = 65 years old < 65 years old0102030405060708090
100
Number of patients who received appropriate or pending BMD follow up vs. inappropriate BMD follow up
InappropriateAppropriate or pending
Num
ber o
f pati
ents
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Results SummarySubjects are more than twice as likely to
take appropriate vitamin D than calciumTaking apprpriate Vitamin D and Calcium
◦Low ICS users = 19%◦Medium ICS users = 21%◦High ICS users = 8%
Having appropriate osteoporosis prophylaxis or being treated for OP◦Low ICS users = 28%◦Medium ICS users = 30%◦High ICS users = 26%
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Results Summary 2
29% of subjects(73/255) were found to be sufficiently supplemented or treated, regardless of dose potency
Either by adequate intake of both calcium and
vitamin D (45 patients) treated for osteoporosis (28 patients)
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Discussion◦High dose ICS users: (at highest risk)
62% ≥ 65 years old (age increases OP risk)
Had lowest appropriate intake of calcium at 13% (7/53)
? Pill size issue, constipation in older age
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Discussion
BMD:◦Majority of eligible subjects received
an initial scan and appropriate follow up
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DiscussionStudy Limitations and Difficulties
◦Health Information Act Data may not represent all of Alberta
◦Restrictions imposed by pharmacy authority
◦Pharmacy settings with a low rate of returning patients
◦Subjective reporting Some subjects could not recall exact year
that they received follow up of BMD Dietary intake of vitamin D and calcium hard
to assess
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Conclusion< 29% of patients are achieving
appropriate osteoporosis prophylaxis or treatment regardless of ICS dose
◦high dose ICS users (highest need of osteoporosis prevention) have lowest prevention/treatment rate (26%)
For patients who qualified for an initial BMD test, 61% received it.
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AcknowledgementsCostco #544 – Sherwood Park, Alberta Shoppers Drug Mart #302 – Edmonton, AlbertaShoppers Drug Mart #312 – Edmonton, AlbertaShoppers Drug Mart #346 – Edmonton, AlbertaShoppers Drug Mart #386 – Edmonton, AlbertaShoppers Drug Mart #2301 – Edmonton, AlbertaLondon Drugs #22 – Edmonton, AlbertaSafeway Capilano – Edmonton, AlbertaSprucewood Pharmacy – Lloydminster, AlbertaWalmart #3118 – Edmonton, AlbertaWalmart #1570 – Camrose, AlbertaWalmart #7236 – Edmonton, Alberta
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Questions?