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Clinicians’ views of prescribing oral and intravenous bisphosphonates for osteoporosis: a qualitative study

Bishop, Simon; Narayanasamy, Melanie Jay; Paskins, Zoe; Corp, Nadia; Bastounis, Anastasios; Griffin, Jill; Gittoes, Neil; Leonardi-Bee, Jo; Langley, Tessa; Sahota, Opinder


Simon Bishop

Melanie Jay Narayanasamy

Anastasios Bastounis

Jill Griffin

Neil Gittoes

Jo Leonardi-Bee

Tessa Langley

Opinder Sahota


Background: Bisphosphonate medications, including alendronate, ibandronate and risedronate administered orally and zoledronate, administered intravenously, are commonly prescribed for the treatment of osteoporosis based on evidence that, correctly taken, bisphosphonates can improve bone strength and lead to a reduction in the risk of fragility fractures. However, it is currently unclear how decisions to select between bisphosphonate regimens, including intravenous regimen, are made in practice and how clinicians support patients with different treatments.

Methods: This was an interpretivist qualitative study. 23 semi-structured telephone interviews were conducted with a sample of general practitioners (GPs), secondary care clinicians, specialist experts as well as those providing and leading novel treatments including participants from a community intravenous (IV) zoledronate service. Data analysis was undertaken through a process of iterative categorisation.

Results: The results report clinicians varying experiences of making treatment choices, as well as wider aspects of osteoporosis care. Secondary care and specialist clinicians conveyed some confidence in making treatment choices including on selecting IV treatment. This was aided by access to diagnostic testing and medication expertise. In contrast GPs reported a number of challenges in prescribing bisphosphonate medications for osteoporosis and uncertainty about treatment choice. Results also highlight how administering IV zoledronate was seen as an opportunity to engage in broader care practices.

Conclusion: Approaches to making treatment decisions and supporting patients when prescribing bisphosphonates for osteoporosis vary in practice. This study points to the need to co-ordinate osteoporosis treatment and care across different care providers.

Journal Article Type Article
Acceptance Date Sep 8, 2023
Online Publication Date Sep 29, 2023
Publication Date Sep 29, 2023
Deposit Date Oct 2, 2023
Publicly Available Date Oct 2, 2023
Journal BMC Musculoskeletal Disorders
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 24
Issue 1
Article Number 770
Keywords Zoledronate, Treatment choice, Qualitative research, Adherence, Bisphosphonate regimens


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his article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

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