Use of drugs that induce osteoporosis or fracture in older adult with myeloma multiple: cross-sectional study
DOI:
https://doi.org/10.30968/rbfhss.2023.142.0922Abstract
Objective: to describe the frequency of use of medications that induce osteoporosis or fracture (MOF) by old adult with multiple myeloma and evaluate associated factors. Methods: cross-sectional study, developed in three settings: a public teaching hospital, a private outpatient onco-hematology service, a public hospital, reference in oncology. Data were collected between April 2019 and March 2020 by means of face-to-face interviews and review of patients’ medical records. The dependent variable was the use of MOF. The drugs were identified in pharmacovigilance studies conducted from the Japanese database of adverse drug event reports and the World Health Organization’s Vigibase that calculated the reporting odds ratio (ROR) of osteoporosis or fracture for the drugs. Factors associated with MOF by patients of study use were determined by multiple logistic regression. The drugs were classified by the fourth level of Anatomical Therapeutic Chemical (ATC) Classification. Results: 153 older adult (≥ 60 years) were included, with a median age of 70.9 years, female predominance (54.2%), and 73.2% of the older adult were using at least one MOF. Most of the older adult (56.9%) were seen in the private health service. The most common comorbidity was hypertension (67.3%), followed by diabetes mellitus (28.8%). The most frequent MOF were proton pump inhibitors (PPIs) (29.2%) and sulfonamides (13.9%) followed by benzodiazepine related drugs (11.9%) and other opioids (10.4%). The older adult who used MOF presented the following characteristics: age up to 70 years, female gender, income up to three salaries, high education (high school or higher), multimorbidity, hypertension and polypharmacy. In multivariate analysis, an independent and positive association was obtained between MOF use and polypharmacy, MOF and high education. Conclusion: the frequency of MOF use by the older adult studied was high and was positively and independently associated with polypharmacy and high education. The ATC classes of MOF with the highest frequency of use were: PPIs, high-ceiling diuretic (sulfonamides), benzodiazepines related drugs and other opioids.
Downloads
References
Cowan, AJ, Green DJ, Kwok M, et al. Diagnosis and Management of Multiple Myeloma: A Review. JAMA. 2022;327(5):464–477. DOI: https://10.1001/jama.2022.0003
Mukkamalla, SKR, Malipeddi D. Myeloma Bone Disease: A Comprehensive Review. Int Jour of Mol Sciences. 2021;22(12):6208. DOI: 10.3390/ijms22126208
Brasil. Ministério da Saúde. Comissão Nacional de Incorporação de Tecnologias do Sistema Único de Saúde (CONITEC). Relatório de recomendação- Diretrizes diagnósticas e terapêuticas do Mieloma Multiplo. 2022. Disponível em: https://www.gov.br/conitec/ptbr/midias/consultas/relatorios/2022/20220526_ddt_mieloma_multiplo_cp.pdf Acesso em 2 set. 2022.
Pop V, Parvu A, Craciun A, et al. Modern markers for evaluating bone disease in multiple myeloma (Review). Exp and Ther Medicine. 2021;22(5). DOI: https://10.3892/etm.2021.10764.
Bernstein ZS, Kim EB, Raje N. Bone Disease in Multiple Myeloma: Biologic and Clinical Implications. Cells. 2022;11(15):2308. DOI: 10.3390/cells11152308.
Thorsteinsdottir S, Gislason G, Aspelund T, et al. Fractures and Survival in Multiple Myeloma: Results from a Population-Based Study. Clin Lymp Mye and Leukemia. 2019;19(10):35. DOI: 10.3324/hematol.2019.230011.
D’oronzo SS, Stucci M, Tucci, et al. Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications. Canc Treat Reviews. 2015; 41(9):798–808. DOI: 10.1016/j.ctrv.2015.09.003.
Kunacheewa C, Orlowski RZ. New Drugs in Multiple Myeloma. Annual Rev of Medicine. 2019;70(1):521–547. DOI: doi: 10.1146/annurev-med-112017-091045
Lane NE. Glucocorticoid-Induced Osteoporosis: New Insights into the Pathophysiology and Treatments. Cur Ost Reports. 2019;17(1):1–7. DOI: https://10.1007/s11914-019-00498-x.
Asfaw AA, Pharm B, Yan CH, et al. Barriers and facilitators of using sensored medication adherence devices in a diverse sample of patients with multiple myeloma: Qualitative study. Journ of Med Int Research. 2018;20(11). DOI: https://10.2196/cancer.9918.
Vogel MN; Weisel K, Maksimovic O, et al. Pathologic fractures in patients with multiple myeloma undergoing bisphosphonate therapy: incidence and correlation with course of disease. Amer jour of roentgenology. 2009;193(3):656–661.
Toci GR, Bressner JA, Morris CD, et al. Can a Novel Scoring System Improve on the Mirels Score in Predicting the Fracture Risk in Patients with Multiple Myeloma? Clin Ort & Rel Research. 2020;479(3):521–530.
Brasil. Lei nº 14.423, de 22 de julho de 2022. Dispõe sobre o Estatuto da Pessoa Idosa e dá outras providências e altera a Lei nº 10.741, de 1º de outubro de 2003, para substituir, em toda a Lei, as expressões “idoso” e “idosos” pelas expressões “pessoa idosa” e “pessoas idosas”, respectivamente. Disponível em: https://www.planalto.gov.br/ccivil_03/_Ato2019-2022/2022/Lei/L14423.htm#art2. Acesso em: 16 jan. 2023.
Toriumi S, Kobayashi A, Sueki H, et al. Exploring the Mechanisms Underlying Drug-Induced Fractures Using the Japanese Adverse Drug Event Reporting Database. Pharmaceuticals. 2021;14(12)1299. DOI: https://doi.org/10.3390/ph14121299.
Batteux B, Bennisuma Y, Bodeau S, et al. Associations between osteoporosis and drug exposure: A post-marketing study of the World Health Organization pharmacovigilance database (VigiBase®). Bone. 2021;153:116137. DOI: 10.1016/j.bone.2021.116137.
Fattahi MR, Niknam R, Shams M, et al. The Association Between Prolonged Proton Pump Inhibitors Use and Bone Mineral Density. Risk Man and He Policy. 2019;12:349–355.
Thong BKS, Ima-nirwana S, Chin, KY. Proton Pump Inhibitors and Fracture Risk: A Review of Current Evidence and Mechanisms Involved. Int Jour of Env Res and Pub Health. 2019;16(9)1571.
By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geri Soc. 2023. DOI: 10.1111/jgs.18372.
Ruths S, Bakken MS, Ranhoff AH, et al. Risk of hip fracture among older people using antihypertensive drugs: a nationwide cohort study. BMC Geriatrics. 2015;15(1). DOI: http://10.1186/s12877-015-0154-5.
Guan Q, Men S, Juurlink DN, et al. Opioid Initiation and the Hazard of Falls or Fractures Among Older Adults with Varying Levels of Central Nervous System Depressant Burden. Drug Aging. 2022;39(9):729-738.
Daniell HW. Opioid osteoporosis. Arch Intern Med. 2004;164(3):338.
Chiu E, Cabanero M, Sidhu G. Paradoxical Stress Fracture in a Patient With Multiple Myeloma and Bisphosphonate Use. Cureus. 2020;12(8). DOI: http://10.7759/cureus.9837.
Tonogai I, Goto T, Hamada D, et al. Bilateral Atypical Femoral Fractures in a Patient with Multiple Myeloma Treated with Intravenous Bisphosphonate Therapy. Cas Rep in Ort. 2014;2014:1-4. DOI: 10.1155/2014/452418.
Chang ST, Tenforde AS, Grimsrud CD, et al. Atypical femur fractures among breast cancer and multiple myeloma patients receiving intravenous bisphosphonate therapy. Bone. 2012;51(3):524–527.
Bahk JH, Jo WL, Kwon SY, Park HC, Lim YW. Weight-Based Bisphosphonate Administration for Multiple Myeloma Patients and the Risks of Skeletal Complications. J Clin Med. 2023;18(12):1637.
Osman A, Kamkar N, Speechle M, et al. Fall Risk-Increasing Drugs and Gait Performance in Community-Dwelling Older Adults: A Systematic Review. Ag Res Reviews. 2022:101599.
Sweiss K, Calip GS, Wirth S, et al. Polypharmacy and potentially inappropriate medication use is highly prevalent in multiple myeloma patients and is improved by a collaborative physician–pharmacist clinic. J Oncol Pharm Practice. 2019;26(3):536–542.
Umit EG, Baysal M, Bas V, et al. Polypharmacy and potentially inappropriate medication use in older patients with multiple myeloma, related to fall risk and autonomous neuropathy. Jour of Onc Pharm Practice. 2019;26(1)43–50.
Masnoon N, Shakib S, Ellett L.K, et al. What is polypharmacy? A systematic review of definitions. BMC geriatrics. 2017;17(1):230. DOI: 10.1186/s12877-017-0621-2.
Machado TRL, Menezes De Pádua CA, Drummond PLM, et al. Use of fall risk-increasing drugs in older adults with multiple myeloma: A cross-sectional study. Jour of Ger Oncology. 2022;13(4):493–498. DOI: 10.1016/j.jgo.2022.01.007.
Oliveira PC, Silveira RM, Ceccato MGB et al. Prevalência e Fatores Associados à Polifarmácia em Idosos Atendidos na Atenção Primária à Saúde em Belo Horizonte-MG, Brasil. Ciê & Sau Coletiva. 2021;26(4):1553–1564. DOI:10.1590/1413-81232021264.08472019.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to RBFHSS: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to RHFHSS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
