Influence of gastrointestinal events on treatment of osteoporosis in Asia-Pacific women: Perspectives from physicians in the MUSIC OS-AP study

Abstract

Background: The objectives of the physician survey component of the MUSIC OS-AP study were to describe physicians' approaches to treatment of women with postmenopausal osteoporosis and to understand the influence of gastrointestinal (GI) events on treatment in clinical practice.

Methods: Physicians were recruited from 5 Asia-Pacific countries. Questionnaires collected information about physicians' standard practices for treatment of patients with osteoporosis, as well as their perspectives on the influence of GI events on osteoporosis treatment approaches.

Results: A total of 59 physicians participated in the study. The most frequently prescribed or recommended treatments were vitamin D (84% of patients), calcium (82%), and oral bisphosphonates (59%). When choosing a medication for treatment-naïve patients, GI sensitivity was often or always a factor for 79% of physicians. Among physicians not prescribing pharmacologic treatment, a mean of 18% of non-prescriptions were due to GI sensitivity. For patients with pre-existing GI conditions, physicians most frequently ranked use of non-oral osteoporosis medication as the first treatment strategy (47%), followed by co-prescription with a proton pump inhibitor or other gastro-protective agent (31%). For patients developing GI symptoms after starting pharmacologic treatment, the most frequently first-ranked management strategy was to check if patients were taking their osteoporosis medication correctly as prescribed (64%), followed by temporary discontinuation of the medication (i.e., a drug holiday) until GI events have resolved (31%) and co-prescription with a proton pump inhibitor or other gastroprotective agent (24%).

Conclusions: These results suggest that GI events influence the prescribing practices of physicians in the Asia-Pacific region and sometimes result in non-treatment of women with osteoporosis.

Keywords: Asia; Australia; BMD, bone mineral density; GI, gastrointestinal; Gastrointestinal diseases; MUSIC, medication use patterns, treatment satisfaction, and inadequate control of osteoporosis study; Osteoporosis, postmenopausal; Osteoporosis/drug therapy; Practice patterns, physicians'.

Fig. 1

Factors that impact osteoporosis therapy among treatment-naïve patients.^{a a}Survey question: when choosing an osteoporosis medication for treatment-naïve postmenopausal women aged 50 years or older, how often do the following factors impact your choice? Renal insufficiency was defined as creatinine clearance < 35 mL/min.

Fig. 2

Frequency of gastrointestinal events among treated patients.^{a a}Survey question: how often do you see the following gastrointestinal events in postmenopausal women aged 50 years or older who are receiving osteoporosis treatment?

Fig. 3

Physician treatment approaches for (a) patients with pre-existing GI conditions and (b) patients developing GI symptoms after starting treatment.^a GI, gastrointestinal; OP, osteoporosis ^aPanel (a) Survey question: If one of your female patients is a candidate for osteoporosis medication(s) and has pre-existing GI events, please rank (from 1, 2, 3…) the normal sequence of treatment options you would select. Panel (b) Survey question: If one of your female patients taking osteoporosis medication(s) develops a GI event, please rank (from 1, 2, 3…) the normal sequence of treatment options you would select.