Medication burden of Saudi Arabian women receiving antiresorptive therapy

Mir Sadat-Ali,¹ Bader Al-Shafie,² Abdallah S Al-Omran,¹ Mohammed Q Azam<sup>1

1</sup>Department of Orthopedic Surgery, College of Medicine, University of Dammam, Dammam, Saudi Arabia; ²Department of Pharmacy, King Fahd Hospital of the University, Al Khobar, Saudi Arabia

Background and purpose: Osteoporosis is common in the Saudi Arabian population, and its successful treatment requires full compliance. Patients who require antiresorptive therapy, such as oral bisphosphonates, may suffer from other diseases requiring medications, which increases the medication burden and ends up in drug noncompliance on the part of patients, making them vulnerable to osteoporosis-related fractures. We decided to undertake this study to analyze the concomitant medications that osteoporotic patients are receiving at King Fahd Hospital of the University, Al Khobar.
Methods: Osteoporotic patients receiving antiresorptive therapy (ART) at King Fahd Hospital of the University, Al Khobar, were identified through the database of the QuadraMed Patient Care system and cross-checked with the radiology database of the dual-energy X-ray absorptiometry scan and pharmacy drug-dispensing system between January 2009 and December 2009. Concomitant medication is defined as the use of other drugs for $30 days with oral bisphosphonates, calcium, and vitamin D. Medication burdens are defined as mild (≤1 concomitant medication), moderate (≥2 and ≤4 medications), and severe (≥5 medications). The demographic data, such as age, sex, and diagnosis, were collected from the medical records. The data were analyzed using the Statistical Package for the Social Sciences (SPSS).
Results: During the study period, 516 patients were diagnosed with osteoporosis, and 473 were on ART while the rest were using anabolic Teriperatide. Sixty-eight (14.4%) of the patients, with an average age of 50.15 ± 2.4 years, were on one medication besides ART, vitamin D, and elemental calcium; 129 (27.3%) of the patients, with an average age of 51.6 ± 9.7 years, were taking 3.32 medications, and 276 (58.3%) of the patients, with a mean age of 62.1 ± 10.7 years, were on 8.02 concomitant medications. The most common concomitant medications in use were cardiac, endocrine, systemic nonsteroidal anti-inflammatory drugs, and analgesics, in that order. This study suggests that the majority of Saudi women who are osteoporotic and undergoing oral bisphosphonate therapy have a concomitant medication burden of $5 other medications. For full compliance with the therapy, the patients' medication burden should be considered prior to selecting the treatment route.

Keywords: osteoporosis, concomitant medications, polypharmacy, compliance