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A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England

Chalitsios, Christos V.; Shaw, Dominick E.; McKeever, Tricia M.


Christos V. Chalitsios

Professor of Epidemiology and Medical Statistics


© 2020, The Author(s). Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect negative binomial regression analysis. There was a rise in OCS and BP prescriptions of 55% and 1200% from 1998 to 2018, respectively. Of the 6586 included practices, the median (IQR) of OCS and BP prescriptions were 120.8 (84.8–160.4) and 107.7 (73.8–147.4) per 1000 patients, respectively. Asthma and chronic obstructive pulmonary disease (COPD) were significantly associated with OCS use (p < 0.0001), but only COPD was associated with BP use (p < 0.0001). Higher OCS prescribing rates were associated with higher BP prescribing rates (5th to 1st quintile—IRR = 1.99; 95% CI: 1.88–2.10). Practice list size, deprivation and advanced age were all associated with both drugs (p < 0.0001). In conclusion, although OCS use is positively associated with BP prescription, variation among practices and CCGs exists. The variation in prescribing suggests there is still a need to improve GIOP prevention.


Chalitsios, C. V., Chalitsios, C. V., Shaw, D. E., & McKeever, T. M. (2020). A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England. npj Primary Care Respiratory Medicine, 30(1),

Journal Article Type Article
Acceptance Date Jan 16, 2020
Online Publication Date Feb 13, 2020
Publication Date Feb 13, 2020
Deposit Date Feb 3, 2020
Publicly Available Date Feb 17, 2020
Journal npj Primary Care Respiratory Medicine
Electronic ISSN 2055-1010
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 30
Issue 1
Article Number 5
Keywords Public Health, Environmental and Occupational Health; Pulmonary and Respiratory Medicine
Public URL
Publisher URL
Additional Information Received: 8 July 2019; Accepted: 16 January 2020; First Online: 13 February 2020; : The authors declare no competing interests.


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