These patients could have had earlier adverse effects for bisphosphonates or had other reasons CH5424802 datasheet for discontinuing these drugs. Moreover, not all patients still used glucocorticoids during follow-up or tapered off the dose, and as a result,

GIOP prophylaxis was no longer required. In the control group, the proportion of GIOP-treated males was twofold lower as compared to females. The neglecting of osteoporosis prophylaxis in males is in line with other studies [11, 14, 23]. The difference in the intervention effect between males and females may be explained by this phenomenon; prescribers may have been more likely to have previously considered osteoporosis prophylaxis in females. The low prescribing rate in the elderly may be explained by the initial belief of physicians that extra treatment with bisphosphonates would be inappropriate due to the presence of multiple co-morbidities or a large number of medicines. On the other hand, elderly patients do have a higher

absolute fracture risk and the consequences of fractures (especially for those of the hip) can be tremendous [24]. The increased prescribing of bisphosphonates for elderly in the intervention group may be explained by an increased awareness for this fact. It should, however, be noted that the power of this study was not calculated specifically for these subgroup analyses. Strengths of this study include its size and the simple set-up of the intervention. In contrast to previous trials, patients and physicians were not KU55933 mouse educated for GIOP and pharmacists only received the recent guideline without further training [19, 21]. This study is therefore a better reflection of the real-life situation. The identification of patients

at risk for GIOP can easily be integrated in the tasks of the pharmacists and is not labour intensive or costly when compared to interventions involving education of physicians and/or patients [25]. However, the lack of an overall significant increase in the number 4��8C of bisphosphonate-treated patients calls for additional measures. The intervention in its present from can be combined with learn more interdisciplinary meetings between pharmacists and general practitioners beforehand and after follow-up, which include feedback about current prescribing and differences between practices. This approach is not very costly and is achievable in daily practice. In addition, clinical rules are currently implemented, and this would make it even easier to extract GIOP-eligible patients from pharmacy information systems. Indeed, a large randomised controlled trial (RCT) showed the significant benefit of a more intensive, pharmacist-led intervention in reducing the number of prescribing errors [26]. Pharmacists did not only give feedback to physicians about medication errors during meetings, but also reviewed medical records and invited the patients. The major limitation of this study is that we do not know how motivated the pharmacists were to perform the intervention.