Testing for vitamin D and other trends in the clinical management of osteoporosis

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Rowell, David
Gordon, Louisa
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Summary This descriptive paper identifies some salient trends in the Australian management of osteoporosis. Changes in pharmaceutical consumption and medical utilisation are analysed. The total national consumption of four pharmaceuticals is estimated. From 2001 to 2011, the consumption of bisphosphonates and vitamin D increased. After 2006, the management rate for osteoporosis decreased. Purpose During the first decade of the millennia, the total cost of vitamin D tests has increased significantly within many health care jurisdictions worldwide. Australia reports a 100-fold increase. Legitimately, concerns regarding the economic effectiveness of this test exist. The purpose of this paper is to identify what other salient clinical trends could affect the efficacy of this test when treating osteoporosis. Methods Longitudinal data from two Australian datasets are analysed. The first are data obtained from Medicare Australia, which report pharmaceutical consumption. The second are data obtained from a national survey of general practitioners. Results The management of osteoporosis has been characterised by a movement away from single to combination formularies. The consumption of calcium carbonate has declined, and the use of bisphosphonates has increased. While the gross consumption of risedronate increased steadily over the decade (8.4 to 186.5 kg), the consumption of alendronate declined after 2007. The consumption of vitamin D (over-the-counter and prescription) has increased from 0.58 to 2.8 kg over the decade. While prescription vitamin D comprised just 10 % of the total, its consumption has undergone a 20-fold increase since 2006. Importantly, we can also report that the management of osteoporosis by Australia's general practitioners increased steadily until 2007-2008, before declining by 36 %. Conclusions Further research is required to determine possible casual relationships that may exist between these data. Until a formal economic evaluation of vitamin D testing in this clinical setting is completed, no conclusions regarding its economic effectiveness should be drawn.

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Archives of Osteoporosis
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