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Anti-Osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis

Anti-Osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis
Anti-Osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis
In January 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of antiosteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorization of a generic form of alendronic acid within the UK. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of antiosteoporosis medication prescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999 to 2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year “intervention period.” We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% CI, 10.9 to 18.9) for incident antiosteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: –0.19% (95% CI, –0.28 to –0.09) and –0.17% (95% CI, –0.26 to –0.09) per 6 months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at 3 years postintervention relative to expected values based solely on preintervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fractures
0884-0431
2008-2015
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Leal, Jose
2bd46ae6-ccca-41c7-a059-966d8c9799aa
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Javaid, Muhammad
f7c2b629-ee25-4db7-a68a-8b6a8133c5c5
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Leal, Jose
2bd46ae6-ccca-41c7-a059-966d8c9799aa
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Javaid, Muhammad
f7c2b629-ee25-4db7-a68a-8b6a8133c5c5
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe

Hawley, Samuel, Leal, Jose, Delmestri, Antonella, Prieto-Alhambra, Daniel, Arden, Nigel, Cooper, Cyrus, Javaid, Muhammad and Judge, Andrew (2016) Anti-Osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis. Journal of Bone and Mineral Research, 31 (11), 2008-2015. (doi:10.1002/jbmr.2882). (PMID:27377877)

Record type: Article

Abstract

In January 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of antiosteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorization of a generic form of alendronic acid within the UK. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of antiosteoporosis medication prescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999 to 2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year “intervention period.” We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% CI, 10.9 to 18.9) for incident antiosteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: –0.19% (95% CI, –0.28 to –0.09) and –0.17% (95% CI, –0.26 to –0.09) per 6 months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at 3 years postintervention relative to expected values based solely on preintervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fractures

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Accepted/In Press date: 29 May 2016
e-pub ahead of print date: 4 July 2016
Additional Information: for the REFReSH Study Group
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 399419
URI: http://eprints.soton.ac.uk/id/eprint/399419
ISSN: 0884-0431
PURE UUID: 43980cff-7384-4116-994d-cb9c023ee6f0
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 16 Aug 2016 13:54
Last modified: 27 Feb 2021 05:01

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Contributors

Author: Samuel Hawley
Author: Jose Leal
Author: Antonella Delmestri
Author: Daniel Prieto-Alhambra
Author: Nigel Arden
Author: Cyrus Cooper ORCID iD
Author: Muhammad Javaid
Author: Andrew Judge

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