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 Results Results Results Results Number of patients who received appropriate or pending BMD follow up vs. inappropriate BMD follow up 100 90 Number of patients 80 70 60 Inappropriate 50 Appropriate or pending 40 30 20 10 0 > or = 65 years old < 65 years old 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 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 Questions?