The bone mineralization medications (bisphosphonates and denosumab) act on bone metabolism, being able to increase bone density and prevent bone loss that occurs in women after menopause. Its use is indicated in postmenopausal osteoporosis and in some cases, also, in osteoporosis suffered by men, which is a risk factor for fall or fragility fractures.
However, it has been proven that after a very prolonged use of these medicines some problems may appear, such as jaw bone damage, femur fractures, or atrial fibrillation. In the case of DenosumabThere have even been reports of fractures when leaving treatment. For this reason, the Spanish Medicines Agency recommended that doctors use drugs for bone mineralization only in patients at high risk of fracture and after considering the possible occurrence of multiple vertebral fractures upon withdrawal of treatment.
A program led by primary pharmacists manages to reduce the use of medications for bone mineralization in people over 80 years of age
Based on this recommendation, and with the aim of identifying errors and potential security problems, the Navalmoral de la Mata Health Area launched the ‘Program for the review of patients under treatment with medications for bone mineralization over 80 years of age‘led by Primary Care Pharmacists and included within the strategies for Patient Safety of the .
The program has enabled primary care pharmacists to identify 204 patients older than 80 years in treatment with medications for bone mineralization with potential security issues after more than five years of treatment.
As stated by María Victoria Muñoz Arroyo, member of the Spanish Society of Primary Care Pharmacists () and project coordinator, «The role of primary care pharmacists in this program is key, since we are the ones who detect those patients who could be at risk due to the use of a certain medication, the ones who review the medical records and inform the doctors so that Evaluate if the medication is necessary. In addition, we remind you that these drugs should be used only in patients at high risk of fracture and that it is necessary to notify any suspected adverse reaction to them; and we also inform them that there are other non-pharmacological measures that prevent fractures, such as physical exercise, a good diet (rich in calcium and vitamin D), quitting tobacco or reducing alcohol consumption».
Of the 204 patients reviewed, the action of primary care pharmacists has achieved discontinuation of treatment in 57 of them, which represents a percentage of almost 30% of those affected and a savings of more than 27,000 euros per year if the price of the medicines that have stopped being prescribed by the doctor is considered. “Most of this saving is for the Public Health System, but also for patients who must pay the corresponding contribution in pharmacies”explains Muñoz Arroyo.
This expert considers, however, that in the reports made by the primary care pharmacists there was sufficient justification for the number of treatment suspensions was higher. «Of the total number of patients reviewed, only 48 (23.53%) had the diagnosis of osteoporosis registered in the electronic Clinical Record, a fact that can indicate two things: or that the health problems are not adequately recorded in the Clinical Record or that these drugs are being used without being indicated»he warns.
After the intervention of primary care pharmacists, 130 patients continue with treatments for bone mineralization without the majority of them the doctor specifies the reason for non-withdrawal. “The non-suspension of these drugs in the patients analyzed should be justified by the medical professional and assessed by the administration, since, in addition to being not very cost-effective, they can put the patient’s health at risk”concludes María Victoria Muñoz Arroyo.