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Predicting osteoporosis medication receipt in Veterans with a spinal cord injury: A retrospective cohort study.

Weaver FM, Le B, Ray C, Miskevics S, Gonzalez B, Carbone LD. Predicting osteoporosis medication receipt in Veterans with a spinal cord injury: A retrospective cohort study. The journal of spinal cord medicine. 2019 Nov 1; 42(6):760-767.

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Abstract:

To describe frequency and predictors of use of pharmacological therapies for osteoporosis in persons with a spinal cord injury (SCI).: Retrospective cohort study. United States Veterans Health Administration (VA) national databases. 11,048 persons with a traumatic SCI who received VA health care between Fiscal Years (FY) 2005-2015. Pharmacy data from VA''s Corporate Data Warehouse were used to identify prescriptions for Food and Drug Administration-approved pharmacological treatments for osteoporosis including bisphosphonates, calcitonin, denosumab, raloxifene and teriparatide. Demographics, clinical and SCI-related characteristics, receipt of a dual energy x-ray absorptiometry (DXA), and prevalent lower extremity fractures were examined to determine factors related to receiving a pharmacological agent for osteoporosis. 1,041 persons (9.4%) had a prescription for a pharmacological agent for osteoporosis; the majority (? = 964, 93.0%) were bisphosphonates. There was a significant decline in the number of these prescriptions from FY 2005 (13.0%) to FY 2015 (2.2%). In multivariable analysis, age ( > 50 years) (OR? = 1.60, 95% CI 1.31-1.94); female sex (OR? = 4.09, 95% CI 2.74-6.09); opioid (OR? = 1.24, 95% CI 1.01-1.51) or corticosteroid (OR? = 1.92, 95% CI 1.01-1.51) prescriptions; complete injury (OR? = 1.26, 95% CI 1.04-1.53); receipt of a DXA scan (OR? = 84.03, 95% CI 59.80-118.07) and prevalent fracture (OR? = 5.43, 95% CI 4.13-7.15) were positive predictors. Black race (OR? = 0.43, 95% CI 0.33-0.57) and obese BMI (OR? = 0.59, 95% CI 0.45-0.76) were negative predictors. Prescriptions for osteoporosis medications for persons with a SCI declined in recent years. The strongest predictors for having filled these prescriptions were having had a DXA or a prevalent fracture.





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