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Bisphosphonates and alendronate

Vocabulary Users
#1

In looking at the concepts sets from the Sisyphus challenge, I noticed that even though alendronate is a bisphosphonate, the concept sets include both. I thought it was redundant, but then I noticed that only some alendronate doses are under bisphosphonate. So for example, this one is under both bisphosphonates and alendronate:

40173612 = 904431 = Alendronic acid 70 MG Oral Tablet

But then this one is only under alendronate:

40173594 = 904396 = Alendronic acid 35 MG Oral Tablet

Therefore, if you want bisphosphonates, you may want to name them all individually. Unless I have done something wrong.

#3

Hi George

I have this hypothesis not sure if it right

Alendronate 35 mg dose is given mostly as prophylaxis dose for postmenopausal patients with family history of osteoporosis while 70mg is the actual treatment dose for osteoporosis patients, so maybe by separating the two conc. into 2 categories in this way when I’m studying positive osteoporosis patients adding ones with dose of 35mg will result in false positive participants and will reflect on prevalence rate and other results
Depending on drug indication and diagnosis you will choose which code you use

I’m still new to OHDSI database so I’m maybe wrong :confused:

#5

Thanks. That’s interesting on alendronate. I’ll have to look at the full range of doses included and excluded.

George

#7

RxNorm is mapped to ATC at the clinical drug level, and in this case, the
alendronic acid 35MG oral tablet is not classified within ATC. Selection
of RxNorm ingredients would subsume all strength/formulations. It’s a good
demonstration of how you need to confirm the ancestral relationships when
you create conceptsets.

#8

Yes, some 70mg tabs are in and some are out of ATC, and 5mg, 10mg, and 14mg are in but 35mg and 40mg are out. Actually some 5 and 10 are in and some are out. May have to do with the country.

Alendronic acid 70 MG Oral Tablet <- in ATC

Alendronic acid 70 MG <- out of ATC

Alendronate 70 MG Delayed Release Oral Tablet <- out of ATC

Therefore, as Patrick said, you have to be careful with ATC classes.

George

#9

Yes, so the most effective way if you want to find all the Drugs with Alendronate, is just to look on descendants of 1557272 ‘Alendronate’ (RxNorm Ingredient)

BTW, now we make some fixes and the next release will have “Alendronic acid 70 MG” in ATC having ATC5 “alendronic acid”
But still, we don’t have “Alendronate 70 MG Delayed Release Oral Tablet” because source we built it from didn’t give ATC crosswalk and also we can’t make a shortcut from “Alendronic acid 70 MG Oral Tablet” to “Alendronate 70 MG Delayed Release Oral Tablet” to ATC because sometimes the same ingredient drugs with different forms can have different ATC.
So still need to investigate to make all clear for ATC.

#10

@Dymshyts:

I think you nailed it. We need to figure this out. Folks should be able to rely on it. Let’s put our heads together. Maybe we could find a heuristic by which we can “inherit” ATC class membership, without running into the trap you mentioned.

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