Tratamiento farmacéutico de fracturas vertebrales sintomáticas en Atención Primaria.
D J Torgerson1, D Sykes2, S Puffer1, P Brown3 and C Cooper4
1 York Trials Unit, Department of Health Sciences, York University, York, UK 2 Eli Lilly Pharmaceuticals, Basingstoke, UK 3 Kings Road Surgery, Mumbles, Swansea, UK 4 MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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: Casecontrol 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.
Annals of the Rheumatic Diseases 2004;63:853-856