Presentation on theme: "Osteoporosis Prevention in Inhaled Cortico-steroid Users Osteoporosis Prevention in Inhaled Cortico-steroid Users Principle Investigators: Hoan Linh Banh,"— Presentation transcript:
Osteoporosis Prevention in Inhaled Cortico-steroid Users 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
Conflicts of Interest Dr Banh and Ms Chan have no conflicts to declare Dr Cave has received research support from GSK, Astra-Zeneca, Novartis. Merck Canada, Grifols, Boeringer-Ingelheim but has no conflict related to this study
Introduction Inhaled 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
GINA Guidelines Patients 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.
Osteoporosis Prevention Calcium 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
Objectives Primary: 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.
Methodology Inclusion: ◦ Age ≥19 years ◦ ICS use ≥ 3 months in the past 12 months ◦ Willing to answer a questionnaire Exclusion: ◦ Difficulty speaking English or cognitively impaired
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)
Results Summary Subjects are more than twice as likely to take appropriate vitamin D than calcium Taking 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%
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)
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
Discussion Many subjects were only taking adequate amounts of one or the other supplement, but not both Subject recall of dietary calcium and vitamin D intake was not consistently accurate So we may have underestimated the number of patients receiving adequate calcium/vitamin D intake
Discussion BMD: ◦ Majority of eligible subjects received an initial scan and appropriate follow up
Discussion Study 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
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.
Acknowledgements Costco #544 – Sherwood Park, Alberta Shoppers Drug Mart #302 – Edmonton, Alberta Shoppers Drug Mart #312 – Edmonton, Alberta Shoppers Drug Mart #346 – Edmonton, Alberta Shoppers Drug Mart #386 – Edmonton, Alberta Shoppers Drug Mart #2301 – Edmonton, Alberta London Drugs #22 – Edmonton, Alberta Safeway Capilano – Edmonton, Alberta Sprucewood Pharmacy – Lloydminster, Alberta Walmart #3118 – Edmonton, Alberta Walmart #1570 – Camrose, Alberta Walmart #7236 – Edmonton, Alberta