Clinicians’ views of prescribing oral and intravenous bisphosphonates for osteoporosis: a qualitative study

Bishop, Simon; Narayanasamy, Melanie Jay; Paskins, Zoe; Corp, Nadia; Bastounis, Anastasios; Griffin, Jill; Gittoes, Neil; Leonardi-Bee, Jo; Langley, Tessa; Sahota, Opinder

Abstract

Background Bisphosphonate medications, including alendronate, ibandronate and risedronate administered orally and zoledronate, administered intravenously, are commonly prescribed for the treatment of osteoporosis based on evidence that, correctly taken, bisphosphonates can improve bone strength and lead to a reduction in the risk of fragility fractures. However, it is currently unclear how decisions to select between bisphosphonate regimens, including intravenous regimen, are made in practice and how clinicians support patients with different treatments. Methods This was an interpretivist qualitative study. 23 semi-structured telephone interviews were conducted with a sample of general practitioners (GPs), secondary care clinicians, specialist experts as well as those providing and leading novel treatments including participants from a community intravenous (IV) zoledronate service. Data analysis was undertaken through a process of iterative categorisation. Results The results report clinicians varying experiences of making treatment choices, as well as wider aspects of osteoporosis care. Secondary care and specialist clinicians conveyed some confidence in making treatment choices including on selecting IV treatment. This was aided by access to diagnostic testing and medication expertise. In contrast GPs reported a number of challenges in prescribing bisphosphonate medications for osteoporosis and uncertainty about treatment choice. Results also highlight how administering IV zoledronate was seen as an opportunity to engage in broader care practices. Conclusion Approaches to making treatment decisions and supporting patients when prescribing bisphosphonates for osteoporosis vary in practice. This study points to the need to co-ordinate osteoporosis treatment and care across different care providers.

• Journal Article Type: Article
• Acceptance Date: Sep 8, 2023
• Online Publication Date: Sep 29, 2023
• Publication Date: 2023
• Deposit Date: Oct 3, 2023
• Publicly Available Date: Oct 5, 2023
• Journal: BMC Musculoskeletal Disorders
• Electronic ISSN: 1471-2474
• Publisher: Springer Science and Business Media LLC
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Article Number: 770
• DOI: https://doi.org/10.1186/s12891-023-06865-1
• Keywords: Bisphosphonate regimens, Adherence, Zoledronate, Qualitative research, Treatment choice
• Public URL: https://nottingham-repository.worktribe.com/output/25390209
• Publisher URL: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06865-1
• Additional Information: Received: 20 March 2023; Accepted: 8 September 2023; First Online: 29 September 2023; : ; : Ethical approval was obtained from the North West- Preston Research Ethics Committee (REF: 19/NW/0714) and all participants gave their informed consent to participate. All aspects of the study were performed in accordance with relevant guidelines and regulations.; : Not applicable.; : The authors declare no competing interests.