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ABSTRACT: Abstract Background: 25-Hydroxyvitamin D [25(OH)D] levels are lower in obese individuals. Determining whether low vitamin D status can predispose weight gain requires a longitudinal study. Methods: From a community-based multicenter U.S. prospective cohort of 9704 (Study of Osteoporotic Fractures [SOF]), 4659 women aged ≥65 with baseline 25(OH)D measurement were followed for 4.5 years. They were weighed at baseline and follow-up visits, and a subset (n=1054) had 25(OH)D levels remeasured at follow-up. Results: Women with 25(OH)D levels ≥30 ng/mL had lower baseline weight (141.6 pounds) compared to women with 25(OH)D levels <30 ng/mL (148.6 pounds) (p<0.001). Overall, 25(OH)D status was not associated with weight change over 4.5 years, although there was a significant interaction between 25(OH)D status and weight change category (loss, gain, stable) (p<0.0001). In women who gained ≥5% weight, those with baseline 25(OH)D levels ≥30 ng/mL gained 16.4 pounds (12.2% of baseline weight) over 4.5 years compared to 18.5 pounds (13.9% of baseline weight) in women with levels <30 ng/mL (p=0.04). In women who lost ≥5% weight or remained stable (<5% weight change), there was no association between 25(OH)D status at baseline and weight change. Among women who gained weight and had 25(OH)D measured at both visits, having sustained or developing 25(OH)D levels ≥30 ng/mL was associated with less weight gain between visits (14.81 vs. 16.34 pounds, p=0.04). Conclusions: Higher 25(OH)D levels are associated with lower weight gains, suggesting low vitamin D status may predispose to fat accumulation.
Journal of Women s Health 06/2012; 21(10):1066-73. · 1.57 Impact Factor
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ABSTRACT: Background: Results of prospective studies examining the association between 25 hydroxyvitamin D (25[OH]D) levels and cognitive decline have been inconsistent. We tested the hypothesis that lower 25(OH)D levels are associated with a greater likelihood of cognitive impairment and risk of cognitive decline. Methods: The study is a cross-sectional and longitudinal analysis of a prospective cohort of 6,257 community-dwelling elderly women followed for 4 years. Global cognitive function was measured by the Modified Mini-Mental State Examination and executive function was measured by Trail Making Test Part B (Trails B). Cognitive impairment at baseline was defined as a score >1.5 SD below the sample mean; cognitive decline was defined as decline from baseline to follow-up >1 SD from mean change in score. Results: Women with very low vitamin D levels had an increased odds of global cognitive impairment at baseline: odds ratio (95% confidence interval), 1.60 (1.05-2.42) for women with 25(OH)D <10 ng/mL (25 nmol/L) compared with those with 25(OH)D levels ≥30 ng/mL (75 nmol/L). Compared with women with baseline 25(OH)D level ≥30 ng/mL (75 nmol/L), women with lower levels had an increased risk of global cognitive decline: odds ratio (95% confidence interval), 1.58(1.12-2.22) for women with levels <10 ng/mL (25 nmol/L), and 1.31 (1.04-1.64) for those with levels 10-19.9 ng/mL (25-49 nmol/L). Levels of 25(OH)D were not associated with executive cognitive function. Conclusions: Low 25(OH)D levels among older women were associated with a higher odds of global cognitive impairment and a higher risk of global cognitive decline.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 03/2012; 67(10):1092-1098. · 4.60 Impact Factor
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Dawn E Alley,
Gregory E Hicks,
Michelle Shardell,
William Hawkes,
Ram Miller,
Rebecca L Craik,
Kathleen K Mangione,
Denise Orwig, Marc Hochberg,
Barbara Resnick,
Jay Magaziner
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ABSTRACT: To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility.
Secondary longitudinal data analysis from two randomized controlled trials
Twelve hospitals in the Baltimore, Maryland, area.
Two hundred seventeen women admitted with hip fracture.
Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture.
Effect size-based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39-0.62) and specificity (0.57-0.76) for improvements in self-reported mobility.
Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations.
Journal of the American Geriatrics Society 08/2011; 59(9):1650-7. · 3.74 Impact Factor
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Denise L Orwig, Marc Hochberg,
Janet Yu-Yahiro,
Barbara Resnick,
William G Hawkes,
Michelle Shardell,
J Richard Hebel,
Perry Colvin,
Ram R Miller,
Justine Golden,
Sheryl Zimmerman,
Jay Magaziner
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ABSTRACT: Hip fracture affects more than 1.6 million persons worldwide and causes substantial changes in body composition, function, and strength. Usual care (UC) has not successfully restored function to most patients, and prior research has not identified an effective restorative program. Our objective was to determine whether a yearlong home-based exercise program initiated following UC could be administered to older patients with hip fracture and improve outcomes.
A randomized controlled trial of 180 community dwelling female patients with hip fracture, 65 years and older, randomly assigned to intervention (n = 91) or UC (n = 89). Patients were recruited within 15 days of fracture from 3 Baltimore-area hospitals from November 1998 through September 2004. Follow-up assessments were conducted at 2, 6, and 12 months after fracture. The Exercise Plus Program was administered by exercise trainers that included supervised and independently performed aerobic and resistive exercises with increasing intensity. Main outcome measures included bone mineral density of the contralateral femoral neck. Other outcomes included time spent and kilocalories expended in physical activity using the Yale Physical Activity Scale, muscle mass and strength, fat mass, activities of daily living, and physical and psychosocial functioning. The effect of intervention for each outcome was estimated by the difference in outcome trajectories 2 to 12 months after fracture.
More than 80% of participants received trainer visits, with the majority receiving more than 3 quarters (79%) of protocol visits. The intervention group reported more time spent in exercise activity during follow-up (P < .05). Overall, small effect sizes of 0 to 0.2 standard deviations were seen for bone mineral density measures, and no significant patterns of time-specific between-group differences were observed for the remaining outcome measures.
Patients with hip fracture who participate in a yearlong, in-home exercise program will increase activity level compared with those in UC; however, no significant changes in other targeted outcomes were detected.
clinicaltrials.gov Identifier: NCT00390741.
Archives of internal medicine 02/2011; 171(4):323-31. · 11.46 Impact Factor
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ABSTRACT: To investigate the separate and combined effects of caregiver status and high stress on mortality risk over 8 years in elderly women.
Prospective cohort study conducted in four U.S. communities followed from 1999/01 (baseline) to December 31, 2007.
Home-based interviews.
Three hundred seventy-five caregiver and 694 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who participated in the baseline Caregiver-SOF interview.
Caregiver status was based on SOF respondents' self-report of performing one or more instrumental or basic activities of daily living for a relative or friend with impairments. Two measures of stress were used: Perceived Stress Scale and stress related to caregiving tasks. All-cause mortality was the outcome.
Caregivers were more stressed than noncaregivers; 19.7% of caregivers and 27.4% of noncaregivers died. Mortality was lower in caregivers than noncaregivers (adjusted hazard ratio, (AHR)=0.74, 95% confidence interval (CI)=0.56-0.89). High-stress respondents had greater mortality risk than low-stress respondents over the first 3 years of follow-up (AHR=1.81, 95% CI=1.16-2.82) but not in later years. Likewise, high-stress caregivers and noncaregivers had higher mortality risk than low-stress noncaregivers, although low-stress caregivers had significantly lower mortality than did noncaregivers, whether perceived stress or caregiving-related stress was measured (AHR=0.67 and 0.57). Similar results were observed in analyses comparing spouse caregivers with married noncaregivers.
Short-term effects of stress, not caregiving per se, may increase the risk of health decline in older caregivers.
Journal of the American Geriatrics Society 03/2010; 58(5):937-43. · 3.74 Impact Factor
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ABSTRACT: A possible familial component to fracture risk may be mediated through a genetic liability to fall recurrently.
Our analysis sample included 186 female sibling-ships (n=401) of mean age 71.9 yr (SD=5.0). Using variance component models, we estimated residual upper-limit heritabilities in fall-risk mobility phenotypes (e.g., chair-stand time, rapid step-ups, and usual-paced walking speed) and in recurrent falls. We also estimated familial and environmental (unmeasured) correlations between pairs of fall-risk mobility phenotypes. All models were adjusted for age, height, body mass index, and medical and environmental factors.
Residual upper-limit heritabilities were all moderate (P<0.05), ranging from 0.27 for usual-paced walking speed to 0.58 for recurrent falls. A strong familial correlation between usual-paced walking speed and rapid step-ups of 0.65 (P<0.01) was identified. Familial correlations between usual-paced walking speed and chair-stand time (-0.02) and between chair-stand time and rapid step-ups (-0.27) were both nonsignificant (P>0.05). Environmental correlations ranged from 0.35 to 0.58 (absolute values), P<0.05 for all.
There exists moderate familial resemblance in fall-risk mobility phenotypes and recurrent falls among older female siblings, which we expect is primarily genetic given that adult siblings live separate lives. All fall-risk mobility phenotypes may be coinfluenced at least to a small degree by shared latent familial or environmental factors; however, up to approximately one-half of the covariation between usual-paced walking speed and rapid step-ups may be due to a common set of genes.
Journal of Applied Physiology 02/2010; 108(5):1142-7. · 3.75 Impact Factor
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ABSTRACT: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stress-buffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers.
Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004.
Home-based interviews.
Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview.
High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview.
Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, P<.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35-0.70), caregivers (adjusted HR=0.44, 95% CI=0.24-0.80) and noncaregivers (adjusted HR=0.50, 95% CI=0.32-0.77).
These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers.
Journal of the American Geriatrics Society 05/2009; 57(4):627-33. · 3.74 Impact Factor
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ABSTRACT: Blood lead concentrations have been associated with increased risk of cardiovascular, cancer, and all-cause mortality in adults in general population and occupational cohorts. We aimed to determine the association between blood lead, all cause and cause specific mortality in elderly, community residing women.
Prospective cohort study of 533 women aged 65-87 years enrolled in the Study of Osteoporotic Fractures at 2 US research centers (Baltimore, MD; Monongahela Valley, PA) from 1986-1988. Blood lead concentrations were determined by atomic absorption spectrometry. Using blood lead concentration categorized as < 8 microg/dL (0.384 micromol/L), and > or = 8 microg/dL (0.384 micromol/L), we determined the relative risk of mortality from all cause, and cause-specific mortality, through Cox proportional hazards regression analysis.
Mean blood lead concentration was 5.3 +/- 2.3 microg/dL (range 1-21) [0.25 +/- 0.11 micromol/L (range 0.05-1.008)]. After 12.0 +/- 3 years of > 95% complete follow-up, 123 (23%) women who died had slightly higher mean (+/- SD) blood lead 5.56 (+/- 3) microg/dL [0.27(+/- 0.14) micromol/L] than survivors: 5.17(+/- 2.0) [0.25(+/- 0.1) micromol/L] (p = 0.09). Women with blood lead concentrations > or = 8 microg/dL (0.384 micromol/L), had 59% increased risk of multivariate adjusted all cause mortality (Hazard Ratio [HR], 1.59; 95% confidence interval [CI], 1.02-2.49) (p = 0.041) especially coronary heart disease (CHD) mortality (HR = 3.08 [CI], (1.23-7.70)(p = 0.016), compared to women with blood lead concentrations < 8 microg/dL(< 0.384 mumol/L). There was no association of blood lead with stroke, cancer, or non cardiovascular deaths.
Women with blood lead concentrations of > or = 8 microg/dL (0.384 micromol/L), experienced increased mortality, in particular from CHD as compared to those with lower blood lead concentrations.
Environmental Health 04/2009; 8:15. · 2.65 Impact Factor
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ABSTRACT: Vertebral fractures are the most common osteoporotic fracture. Hip and clinical fractures are less common in black women, but there is little information on vertebral fractures. We studied 7860 white and 472 black women >or=65 yr of age enrolled in the Study of Osteoporotic Fractures. Prevalent vertebral fractures were identified from lateral spine radiographs using vertebral morphometry and defined if any vertebral height ratio was >3 SD below race-specific means for each vertebral level. Information on risk factors was obtained by questionnaire or examination. Lumbar spine, total hip, and femoral neck BMD and BMC were measured by DXA. The prevalence of vertebral fractures was 10.6% in black and 19.1% in white women. In age-adjusted logistic regression models, a 1 SD decrease in femoral neck BMD was associated with 47% increased odds of fracture in black women (OR = 1.47; 95% CI, 1.12-1.94) and 80% increased odds in white women (OR = 1.80; 95% CI, 1.68-1.94; interaction p = 0.14). The overall lower odds of fracture among black women compared with white women was independent of femoral neck BMD and other risk factors (OR = 0.51; 95% CI, 0.37-0.72). However, the prevalence of vertebral fractures increased with increasing number of risk factors in both groups. The prevalence of vertebral fractures is lower in black compared with white women but increases with age, low BMD, and number of risk factors.
Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2008; 23(9):1458-67. · 6.04 Impact Factor
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Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 10/2007; 23(3):455 - 455. · 6.04 Impact Factor
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ABSTRACT: To determine if alendronate had differential effects on BMD and fracture by renal function, we performed a secondary data analysis of women participating in the FIT. Alendronate increased BMD and decreased fractures to a similar degree among women with and without reduced renal function. There was no increase in adverse events among women with impaired renal function treated with alendronate. Alendronate is safe and effective among this group of women with reduced renal function.
Alendronate is cleared by the kidney and may have sustained effects on bone in subjects with impaired renal function. We hypothesized that, with decreasing renal function, alendronate treatment would result in greater increases in BMD and greater decreases in fractures and that the frequency of adverse events would be increased.
We studied women participating in the Fracture Intervention Trial (FIT), a randomized controlled trial of alendronate or placebo (n = 6458). We estimated baseline creatinine clearance (eGFR) using the Cockcroft Gault Formula.
Five hundred eighty-one (9.9%) participants had a severely reduced eGFR (<45 ml/minute). Alendronate increased BMD regardless of eGFR, but women with reduced eGFR had a 5.6% (95% CI: 4.8-6.5) increase in total hip BMD compared with 4.8% (95% CI: 4.6-5.0) among women with normal to moderate renal dysfunction (interaction: p = 0.04). Compared with placebo, alendronate increased spine BMD by 6.6 +/- 5.8%, but there was no significant interaction for the increase in spine BMD (interaction: p = 0.75). Treatment with alendronate reduced the risk of clinical fractures to a similar degree in those with (OR: 0.78; 95% CI: 0.51-1.21) and without reduced renal function (OR: 0.80; 95% CI; 0.70-0.93; p for interaction = 0.89). Treatment with alendronate reduced the risk of spine fractures to a similar degree in those with (OR: 0.72; 95% CI: 0.31-1.7) and without reduced renal function (OR: 0.50; 95% CI: 0.32-0.76; p for interaction = 0.44). There were no differences in adverse events by renal function.
Alendronate is safe and effective at increasing BMD and decreasing fractures among this group of women with reduced renal function.
Journal of Bone and Mineral Research 05/2007; 22(4):503-8. · 6.37 Impact Factor
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ABSTRACT: Elderly caregivers report less leisure-time physical activity than same-aged non-caregivers. However, through caregiving tasks, caregivers may be as physically active as non-caregivers. This study compared leisure-time exercise and overall physical activity in elderly women caregivers and non-caregivers.
The sample included 179 caregivers (153 cared for spouses and 26 for other relatives or friends) and 670 non-caregivers who were participants in the Study of Osteoporotic Fractures. Leisure-time exercise was based on respondents' report of walking for exercise or other regular exercise at least once a week. High overall physical activity included leisure-time exercise or being in the top quartile of walking and climbing stairs during one's daily routine.
Leisure-time exercise was lower in spouse caregivers (adjusted odds ratio (OR) and 95% confidence interval (CI) = 0.64, 0.41-1.00) and non-spouse caregivers (OR = 0.39, 95% CI = 0.16-0.95) than married non-caregivers. Differences in overall physical activity between caregivers and married non-caregivers were smaller and not statistically significant. Caregivers who climbed stairs at least 15 min/day during caregiving tasks reported more overall physical activity than non-caregivers (OR = 4.06, 95% CI = 1.23-13.36).
Studies comparing physical activity in caregivers and non-caregivers should assess activities performed during routine caregiving tasks.
Preventive Medicine 10/2006; 43(3):226-9. · 3.22 Impact Factor
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Sydney Bonnick,
Kenneth G Saag,
Douglas P Kiel,
Michael McClung, Marc Hochberg,
Sherri-Ann M Burnett,
Anthony Sebba,
Risa Kagan,
Erluo Chen,
Desmond E Thompson,
Anne E de Papp
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ABSTRACT: A 1-yr extension of the Fosamax Actonel Comparison Trial was completed to compare changes in bone mineral density (BMD), bone turnover, and upper gastrointestinal tolerability over 2 yr of treatment.
This was a randomized, double-blind extension conducted at 72 U.S. sites.
Of the 1053 women who completed yr 1, 833 postmenopausal women with low BMD entered the extension, continuing their same treatment allocation [once-weekly (OW) alendronate 70 mg or OW risedronate 35 mg]. Changes in BMD at the hip trochanter, total hip, femoral neck, and lumbar spine and in markers of bone turnover were compared at 24 months. Tolerability was assessed by adverse experience reporting.
Alendronate produced greater increases from baseline in BMD at 24 months than did risedronate at the trochanter (alendronate, 4.6%; risedronate, 2.5%, P < 0.001) as well as at all other BMD sites. Significantly more alendronate than risedronate patients had measured BMD increases of 0% or more and 3% or more at all BMD sites (P < 0.001), and fewer alendronate patients had measured decreases of 3% or more at all BMD sites. Significantly greater reductions in all biochemical markers of bone turnover occurred with alendronate, compared with risedronate. No differences were seen in occurrence or discontinuations due to upper gastrointestinal adverse experiences.
Patients receiving 70 mg OW alendronate had greater gains in BMD, were more likely to maintain or gain BMD, and had greater reductions in bone turnover markers than patients receiving 35 mg OW risedronate after 24 months, with no differences in upper gastrointestinal tolerability.
Journal of Clinical Endocrinology & Metabolism 07/2006; 91(7):2631-7. · 6.50 Impact Factor
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ABSTRACT: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women.
Longitudinal study of changes in hip BMD.
Four U.S. clinical centers.
Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures.
Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated.
The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (-0.574%/y vs -0.334%/y) and femoral neck (-0.515%/y vs -0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (-0.57% vs -0.22%) in Caucasians and (-0.35% vs 0.64%) in African Americans (interaction P=.03).
The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified.
Journal of the American Geriatrics Society 03/2005; 53(2):183-9. · 3.74 Impact Factor
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ABSTRACT: We used data from the Fracture Intervention Trial to assess the relationship change in bone turnover after 1 year of alendronate or placebo treatment and subsequent hip, non-spine, and spine fracture risk among 6186 postmenopausal women. In the alendronate group (n = 3105), greater reductions in one or more biochemical marker were associated with a lower risk of fracture.
There are few data on the relationship between short-term change in biochemical markers of bone turnover and non-spine fracture risk among bisphosphonate-treated women, and the clinical use of such measurements is unknown.
We measured biochemical markers of bone turnover (bone-specific alkaline phosphatase [bone ALP], intact N-terminal propeptide of type I collagen, and C-terminal crosslinked telopeptide of type 1 collagen) and BMD of the spine and hip at baseline and after 1 year of alendronate or placebo. During a mean follow-up of 3.6 years, 72 hip, 786 non-spine, and 336 vertebral fractures were documented.
Each 1 SD reduction in 1-year change in bone ALP was associated with fewer spine (odds ratio = 0.74; CI: 0.63, 0.87), non-spine (relative hazard [RH] = 0.89; CI: 0.78, 1.00; p < 0.050), and hip fractures (RH = 0.61; CI: 0.46, 0.78). Alendronate-treated women with at least a 30% reduction in bone ALP had a lower risk of non-spine (RH = 0.72; CI: 0.55, 0.92) and hip fractures (RH = 0.26; CI: 0.08, 0.83) relative to those with reductions <30%. We conclude that greater reductions in bone turnover with alendronate therapy are associated with fewer hip, non-spine, and vertebral fractures, and the effect is at least as strong as that observed with 1-year change in BMD.
Journal of Bone and Mineral Research 08/2004; 19(8):1250-8. · 6.37 Impact Factor
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ABSTRACT: Previous studies of 3-tier formularies are rare, although the evidence suggests that their cost-sharing structure reduces overall drug spending. However, it is unclear how incentive-based formularies affect the selection of medications with safety advantages, or restrict the access that high-risk populations have to recommended therapies in the higher tiers. This study was designed to determine whether 3-tier formularies influence the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in a population of patients with arthritis.
This retrospective study used the 2000 MarketScan Research Database, which contains person-level claims data for employer-sponsored health plans. The sample for this study consisted of 20 868 individuals treated for osteoarthritis or rheumatoid arthritis and using NSAIDs while enrolled in tiered drug plans (n = 32). The likelihood of any use of cyclo-oxygenase (COX-2)-selective inhibitors was determined as a function of tiered drug plan coverage, adjusting for other person-level and plan-level covariates.
Use of COX-2-selective inhibitors decreased (63.0% vs 53.6% vs 41.6%, respectively) and use of generic NSAIDs increased (37.7% vs 40.7% vs 55.7%, respectively) as formularies incorporated 1, 2, and 3 tiers. Enrollees in 3-tier plans with arthritis and serious gastrointestinal comorbidities (odds ratio, 0.51; 95% confidence interval, 0.40-0.66) were significantly less likely to use COX-2-selective inhibitors compared with patients in 1-tier plans.
Three-tier formularies appear to reduce the use of COX-2-selective inhibitors among all patients with arthritis, even those at risk of experiencing gastrointestinal complications from using nonselective NSAIDs. These findings are among the first to suggest that tiered-copayment drug plans may be influencing the selection of medications beyond generic and branded products.
Archives of Internal Medicine 164(15):1679-84. · 11.46 Impact Factor
