Inflammatory conditions such as eczema, asthma and chronic obstructive pulmonary disease are sometimes treated with steroid tablets (e.g. prednisolone). Steroids are drugs that reduce inflammation. However, steroids can increase the risk of breaking a bone. Risk of bone breaks due to weakened bones can be lowered through bone-strengthening medication.
It is likely that people are prescribed steroid tablets in different patterns, e.g. some people receiving high doses at once and other receiving equally high doses over multiple prescriptions. In this study we want to investigate if the pattern of how steroid tablets are prescribed affects how people get prescribed bone-strengthening medication by their general practitioner (GP). We will also investigate whether the pattern of prescribing steroid tablets has an effect on the frequency of bone breaks.
Through this study we might be able to learn if bone breaks may be prevented through better management of drug prescriptions in some people.
Background: Inflammatory conditions, inlcuding eczema, asthma and chronic obstructive pulmonary disease (COPD) are sometimes treated with oral corticosteroids (OCS). It is well established that OCSs increase fracture risk. Fracture-preventive care medications, like bisphosphonates, can be used to counter OCS’ negative effects on bone health.
People are prescribed high doses of OCSs in different patterns. We hypothesise that in people receiving the same cumulative OCS dose, the pattern of how this dose was prescribed effects the likelyhood of receiving adequate fracture-preventive care, potentially leading to a shortfall in preventive care.
Objectives: We will: 1) describe patterns of OCS use in people with inflammatory conditions; 2) compare rates of fracture preventive care by pattern of OCS use in people having received a high cumulative OCS dose; 3) compare rates of fractures by pattern of OCS use in people having received a high cumulative OCS dose.
Methods: We will initially describe characteristics and patterns of OCS use in adults (18+). In older people (>=66 years, bisphosphonate prescribing uncommon in younger people) receiving high cumulative doses of OCS (i.e., >450mg prednisolone equivalent dose within 6 months), we will use Cox regression to estimate hazard ratios, comparing rates of fracture-preventative care and fractures in people with high intensity OCS use compared to low intensity OCS use. We will estimate crude and confounder adjusted hazard ratios.
Relevance: If there is a difference in fracture-preventive-care receipt by pattern of OCS prescription, our results will highlight a gap in appropriate care and inform management of patients prescribed OCSs.
Patterns of OCS use; Fracture preventive care (prescriptions for anti-osteoporosis medications); Major osteoporotic fractures (hip, spine, wrist, and pelvis)
Sinead Langan - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Julian Matthewman - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Daniel Prieto-Alhambra - Collaborator - University of Oxford
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Practice Level Carstairs Index (Excluding Northern Ireland)