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2. Osteoporosis identification among previously undiagnosed individuals with vertebral fractures

Author

Gold, L. S., Cody, R. F., Tan, W. K., Marcum, Z. A., Meier, E. N., Sherman, K. J., James, K. T., Griffith, B., Avins, A. L., Kallmes, D. F., Suri, P., Friedly, J. L., Heagerty, P. J., Deyo, R. A., Luetmer, P. H., Rundell, S. D., Haynor, D. R., and Jarvik, J. G.

Subjects
Adult, Male, Bone Density, Endocrinology, Diabetes and Metabolism, Humans, Mass Screening, Osteoporosis, Spinal Fractures, Female, Article, Osteoporotic Fractures, Aged
Abstract

Because osteoporosis is under-recognized in patients with vertebral fractures, we evaluated characteristics associated with osteoporosis identification. Most patients with vertebral fractures did not receive evaluation or treatment for osteoporosis. Black, younger, and male participants were particularly unlikely to have had recognized osteoporosis, which could increase their risk of negative outcomes.Vertebral fractures may be identified on imaging but fail to prompt evaluation for osteoporosis. Our objective was to evaluate characteristics associated with clinical osteoporosis recognition in patients who had vertebral fractures detected on their thoracolumbar spine imaging reports.We prospectively identified individuals who received imaging of the lower spine at primary care clinics in 4 large healthcare systems who were eligible for osteoporosis screening and lacked indications of osteoporosis diagnoses or treatments in the prior year. We evaluated characteristics of participants with identified vertebral fractures that were associated with recognition of osteoporosis (diagnosis code in the health record; receipt of bone mineral density scans; and/or prescriptions for anti-osteoporotic medications). We used mixed models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs).A total of 114,005 participants (47% female; mean age 65 (interquartile range: 57-72) years) were evaluated. Of the 8579 (7%) participants with vertebral fractures identified, 3784 (44%) had recognition of osteoporosis within the subsequent year. In adjusted regressions, Black participants (OR (95% CI): 0.74 (0.57, 0.97)), younger participants (age 50-60: 0.48 (0.42, 0.54); age 61-64: 0.70 (0.60, 0.81)), and males (0.39 (0.35, 0.43)) were less likely to have recognized osteoporosis compared to white participants, adults aged 65 + years, or females.Individuals with identified vertebral fractures commonly did not have recognition of osteoporosis within a year, particularly those who were younger, Black, or male. Providers and healthcare systems should consider efforts to improve evaluation of osteoporosis in patients with vertebral fractures.

Published
2022
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3. Potential drug-drug and drug-disease interactions in well-functioning community-dwelling older adults.

Author

Hanlon, J. T., Perera, S., Newman, A. B., Thorpe, J. M., Donohue, J. M., Simonsick, E. M., Shorr, R. I., Bauer, D. C., and Marcum, Z. A.

Subjects
ASPIRIN, CONFIDENCE intervals, DRUG interactions, DRUGS, NONPRESCRIPTION drugs, HOSPITAL care, ANTIHYPERTENSIVE agents, LONGITUDINAL method, NONSTEROIDAL anti-inflammatory agents, PEPTIC ulcer, PROBABILITY theory, QUESTIONNAIRES, RESEARCH funding, RISK assessment, DISEASE prevalence, CROSS-sectional method, POLYPHARMACY, DATA analysis software, DESCRIPTIVE statistics, ODDS ratio, OLD age
Abstract

What is known and objective There are few studies examining both drug-drug and drug-disease interactions in older adults. Therefore, the objective of this study was to describe the prevalence of potential drug-drug and drug-disease interactions and associated factors in community-dwelling older adults. Methods This cross-sectional study included 3055 adults aged 70-79 without mobility limitations at their baseline visit in the Health Aging and Body Composition Study conducted in the communities of Pittsburgh PA and Memphis TN, USA. The outcome factors were potential drug-drug and drug-disease interactions as per the application of explicit criteria drawn from a number of sources to self-reported prescription and non-prescription medication use. Results Over one-third of participants had at least one type of interaction. Approximately one quarter (25·1%) had evidence of had one or more drug-drug interactions. Nearly 10·7% of the participants had a drug-drug interaction that involved a non-prescription medication. % The most common drug-drug interaction was non-steroidal anti-inflammatory drugs (NSAIDs) affecting antihypertensives. Additionally, 16·0% had a potential drug-disease interaction with 3·7% participants having one involving non-prescription medications. The most common drug-disease interaction was aspirin/NSAID use in those with history of peptic ulcer disease without gastroprotection. Over one-third (34·0%) had at least one type of drug interaction. Each prescription medication increased the odds of having at least one type of drug interaction by 35-40% [drug-drug interaction adjusted odds ratio (AOR) = 1·35, 95% confidence interval (CI) = 1·27-1·42; drug-disease interaction AOR = 1·30; CI = 1·21-1·40; and both AOR = 1·45; CI = 1·34-1·57]. A prior hospitalization increased the odds of having at least one type of drug interaction by 49-84% compared with those not hospitalized (drug-drug interaction AOR = 1·49, 95% CI = 1·11-2·01; drug-disease interaction AOR = 1·69, CI = 1·15-2·49; and both AOR = 1·84, CI = 1·20-2·84). What is new and conclusion Drug interactions are common among community-dwelling older adults and are associated with the number of medications and hospitalization in the previous year. Longitudinal studies are needed to evaluate the impact of drug interactions on health-related outcomes. [ABSTRACT FROM AUTHOR]

Published
2017
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