Many Canadian doctors will remember the flocks of arthritis
patients that were drawn by images of windsurfing septuagenarians
in cross-border advertising for Cox-2 inhibitors. It's
become accepted wisdom that new drugs create new patients.
And, in the US, according to a review in the July 26 issue
of the Archives of Internal Medicine, this phenomenon
has now spread to the field of osteoporosis.
The research highlights one startling
fact: "The number of physician visits for osteoporosis
increased four-fold between 1994 (1.3 million visits)
and 2003 (6.3 million visits), whereas it had remained
stable in prior years. This increase coincided with
the availability of oral daily bisphosphonates and the
selective estrogen receptor modulator raloxifene."
Until 1994, treatment options were
essentially limited to calcium and estrogens, with a
few lucky patients trying out bisphosphonates. The arrival
of oral daily bisphosphonates, and the selective estrogen
receptor modulator raloxifene on the scene, changed
the picture completely.
Dr Randall Stafford and colleagues
from the Stanford Prevention Research Center, Stanford
University, have tracked visiting and prescribing trends
in osteoporosis since 1988, using nationally representative
data on prescribing patterns of office-based US physicians
from the IMS HEALTH National Disease and Therapeutic
Index.
They found that not only had visits
increased fourfold from 1994 to 2003, but that more
patients were coming away with prescriptions. In 1988,
18% of patients who saw a doctor for osteoporosis came
away with no drug prescription. By 2003, the proportion
that left the doctor's office empty-handed had fallen
to 3%.
The improvement was most marked
in prescriptions for the newer drugs. "Between 1994
and 2003, the percentage of visits where bisphosphonates
and raloxifene were prescribed increased from 14% to
73% and from 0% to 12%, respectively, while prescriptions
for other medications declined," the authors report.
"Treatment of osteoporosis has
improved in recent years in association with the availability
of new medications. Physicians are prescribing drugs
with greater effectiveness and convenience, and recognition
of osteoporosis is increasing," they write. And the
trend is only likely to increase. For one thing, both
bisphosphonates and raloxifene could play a role in
preventing osteoporosis as well as treating it. And
we may soon be looking for new ways to prevent osteoporosis,
since the role of estrogens is very much in doubt.
Osteoporosis is precisely the sort
of disease that's likely to be a growing burden on Canadian
healthcare in years to come, as the population ages.
It's one disease in a long list of chronic age-related
conditions that eat giant holes in the drug budget.
It's uncharitable, but perhaps reasonable to wonder
if the bureaucrats who run drug formularies would really
welcome growing public awareness of new treatment options
for the disease.
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