Explaining osteoporosis drug prescribing trends
: qualitative analyses in England and France

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Osteoporosis has undergone a rapid expansion and a decline more recently of pharmaceutical treatments. This study aims to explain osteoporosis drug prescribing trends in England and France.

Methods: First, a systematic literature review was employed to describe drug prescribing trends and patterns. Second, a documentary analysis of public health policy documents was used to understand the prescribing framework. Third, semi-structured interviews with healthcare professionals practicing in England and France familiar with osteoporosis management were conducted in order to study prescriber decision-making processes.

Findings: The systematic review showed evidence of relatively similar trends in osteoporosis drug prescribing in both England and France: a slow increase between the 1980s and mid-1990s, followed by an intense increase between the mid-1990s and late 2000s and marked prescribing decline in the subsequent years. The review also evidenced the preponderance of alendronate prescriptions in England, as opposed to the relatively greater diversity of treatments in France. The documentary analysis revealed that, from the mid-1990s to the early 2010s, policies showed intense support of pharmaceutical prescribing, particularly favouring marketing authorisations, extensions of therapeutic indications and the development of guidelines. The interviews showed that, with diagnosis essentially revolving around bone density scans, the decision to investigate osteoporosis varied according to the country and medical specialty. Prescribers in England more commonly used the FRAX score while prescribers in France more frequently referred the patient to a rheumatologist for diagnosis.

Conclusions: As the first described case of depharmaceuticalisation in geriatrics, this study finds that osteoporosis is decreasingly perceived as requiring a pharmaceutical response. Pharmaceutical management of osteoporosis has entered a profound crisis where physicians display self-doubt associated with declining trust in pharmaceutical products and/or seek guidance from health authorities. Osteoporosis is marked by declining support for antiosteoporotic medications from health authorities and shifting perceptions towards older age.
Date of Award1 Jul 2020
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorAnthea Tinker (Supervisor), John Abraham (Supervisor), Debora Price (Supervisor), Karen Lowton (Supervisor) & Courtney Davis (Supervisor)

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