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Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases.
Mayo Clin Proc. 2006 Aug; 81(8):1013-22.MC

Abstract

OBJECTIVE

To characterize the relationships between adherence (complance and persistence) to bisphosphonate therapy and risk of specific fracture types in postmenopausal women.

PATIENTS AND METHODS

Data were collected from 45 employers and 100 health plans in the continental United States from 2 claims databases during a 5-year period (January 1, 1999, through December 31, 2003). Claims from patients receiving a bisphosphonate prescription (alendronate or risedronate) were evaluated for 6 months before the Index prescription and during 24 months of follow-up to determine total, vertebral, and nonvertebral osteoporotic fractures, persistence (no gap in refills for >30 days during 24 months), and refill compliance (medication possession ratio > or = 0.80).

RESULTS

The eligible cohort included 35,537 women (age, > or = 45 years) who received a bisphosphonate prescription. A subgroup with a specified diagnosis of postmenopausal osteoporosis was also evaluated. Forty-three percent were refill compliant, and 20% persisted with bisphosphonate therapy during the 24-month study period. Total, vertebral, nonvertebral, and hip fractures were significantly lower in refill-compliant and persistent patients, with relative risk reductions of 20% to 45%. The relationship between adherence and fracture risk remained significant after adjustment for baseline age, concomitant medications, and fracture history. There was a progressive relationship between refill compliance and fracture risk reduction, commencing at refill compliance rates of approximately 50% and becoming more pronounced at compliance rates of 75% and higher.

CONCLUSIONS

Adherence to bisphosphonate therapy was associated with significantly fewer fractures at 24 months. Increasing refill compliance levels were associated with progressively lower fracture rates. These findings suggest that incremental changes in medication-taking habits could improve clinical outcomes of osteoporosis treatment.

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Authors+Show Affiliations

Siris ES
Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, Harkness Pavilion 9-964, 180 Fort Washington Ave, New York, NY 10032, USA. es27@columbia.edu
Harris ST
No affiliation info available
Rosen CJ
No affiliation info available
Barr CE
No affiliation info available
Arvesen JN
No affiliation info available
Abbott TA
No affiliation info available
Silverman S
No affiliation info available

MeSH

AgedDiphosphonatesDrug PrescriptionsFemaleFollow-Up StudiesHip FracturesHumansIncidenceInsurance Claim ReviewMiddle AgedOsteoporosis, PostmenopausalPatient ComplianceRetrospective StudiesRisk FactorsSpinal FracturesWrist Injuries

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16901023

Citation

Siris, Ethel S., et al. "Adherence to Bisphosphonate Therapy and Fracture Rates in Osteoporotic Women: Relationship to Vertebral and Nonvertebral Fractures From 2 US Claims Databases." Mayo Clinic Proceedings, vol. 81, no. 8, 2006, pp. 1013-22.
Siris ES, Harris ST, Rosen CJ, et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc. 2006;81(8):1013-22.
Siris, E. S., Harris, S. T., Rosen, C. J., Barr, C. E., Arvesen, J. N., Abbott, T. A., & Silverman, S. (2006). Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clinic Proceedings, 81(8), 1013-22.
Siris ES, et al. Adherence to Bisphosphonate Therapy and Fracture Rates in Osteoporotic Women: Relationship to Vertebral and Nonvertebral Fractures From 2 US Claims Databases. Mayo Clin Proc. 2006;81(8):1013-22. PubMed PMID: 16901023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. AU - Siris,Ethel S, AU - Harris,Steven T, AU - Rosen,Clifford J, AU - Barr,Charles E, AU - Arvesen,James N, AU - Abbott,Thomas A, AU - Silverman,Stuart, PY - 2006/8/12/pubmed PY - 2006/8/23/medline PY - 2006/8/12/entrez SP - 1013 EP - 22 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 81 IS - 8 N2 - OBJECTIVE: To characterize the relationships between adherence (complance and persistence) to bisphosphonate therapy and risk of specific fracture types in postmenopausal women. PATIENTS AND METHODS: Data were collected from 45 employers and 100 health plans in the continental United States from 2 claims databases during a 5-year period (January 1, 1999, through December 31, 2003). Claims from patients receiving a bisphosphonate prescription (alendronate or risedronate) were evaluated for 6 months before the Index prescription and during 24 months of follow-up to determine total, vertebral, and nonvertebral osteoporotic fractures, persistence (no gap in refills for >30 days during 24 months), and refill compliance (medication possession ratio > or = 0.80). RESULTS: The eligible cohort included 35,537 women (age, > or = 45 years) who received a bisphosphonate prescription. A subgroup with a specified diagnosis of postmenopausal osteoporosis was also evaluated. Forty-three percent were refill compliant, and 20% persisted with bisphosphonate therapy during the 24-month study period. Total, vertebral, nonvertebral, and hip fractures were significantly lower in refill-compliant and persistent patients, with relative risk reductions of 20% to 45%. The relationship between adherence and fracture risk remained significant after adjustment for baseline age, concomitant medications, and fracture history. There was a progressive relationship between refill compliance and fracture risk reduction, commencing at refill compliance rates of approximately 50% and becoming more pronounced at compliance rates of 75% and higher. CONCLUSIONS: Adherence to bisphosphonate therapy was associated with significantly fewer fractures at 24 months. Increasing refill compliance levels were associated with progressively lower fracture rates. These findings suggest that incremental changes in medication-taking habits could improve clinical outcomes of osteoporosis treatment. SN - 0025-6196 UR - https://www.unboundmedicine.com/medline/citation/16901023/Adherence_to_bisphosphonate_therapy_and_fracture_rates_in_osteoporotic_women:_relationship_to_vertebral_and_nonvertebral_fractures_from_2_US_claims_databases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)61201-9 DB - PRIME DP - Unbound Medicine ER -