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Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study.
Curr Med Res Opin. 2006 Sep; 22(9):1757-64.CM

Abstract

INTRODUCTION

International guidelines on the treatment and prevention of osteoporosis recommend the use of bisphosphonates to prevent fractures in this population. However, low persistent use of bisphosphonates could considerably limit the prevention of fractures in clinical practice.

OBJECTIVE

This study aimed to investigate the association between persistent use of bisphosphonates and the risk of osteoporotic fractures in clinical practice.

METHODS

Data were obtained from the PHARMO Record Linkage System, which includes, among other databases, drug-dispensing records from community pharmacies linked to hospital discharge records of more than two million subjects in defined areas in the Netherlands. Persistence with bisphosphonate therapy was assessed during a period of 3 years. A nested matched case control study (cases:controls = 1:10) was performed to study the association between persistent bisphosphonate use and hospitalisation for osteoporotic fractures and analysed by conditional logistic regression analysis. The analyses were adjusted for patient characteristics such as previous hospitalisations for fractures, co-morbidity and co-medication.

RESULTS

14,760 new female users of bisphosphonates were identified of which 541 women had a hospitalisation for osteoporotic fracture after start of bisphosphonate treatment (1-3 years follow-up). One-year persistence rates increased from 33% with alendronate daily to 48% with alendronate weekly, an increase of 15%. Similar results were obtained with risedronate daily and weekly. One year persistent use of bisphosphonates resulted in a statistical significant 26% lower fracture rate (OR 0.74; 95%CI 0.57-0.95) whereas 2 year persistent use resulted in a 32% lower rate (OR 0.68; 95%CI 0.47-0.96).

CONCLUSIONS

Persistent use of bisphosphonates decreases the risk of osteoporotic fractures in clinical practice. Approximately 6% of fractures among users of bisphosphonates could be prevented if persistence was improved by 20%. However, current persistence with bisphosphonate therapy is suboptimal and strategies that further increase persistence are likely to further prevent the number of fractures.

Authors+Show Affiliations

PHARMO Institute, Utrecht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16968579

Citation

van den Boogaard, C H A., et al. "Persistent Bisphosphonate Use and the Risk of Osteoporotic Fractures in Clinical Practice: a Database Analysis Study." Current Medical Research and Opinion, vol. 22, no. 9, 2006, pp. 1757-64.
van den Boogaard CH, Breekveldt-Postma NS, Borggreve SE, et al. Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. Curr Med Res Opin. 2006;22(9):1757-64.
van den Boogaard, C. H., Breekveldt-Postma, N. S., Borggreve, S. E., Goettsch, W. G., & Herings, R. M. (2006). Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. Current Medical Research and Opinion, 22(9), 1757-64.
van den Boogaard CH, et al. Persistent Bisphosphonate Use and the Risk of Osteoporotic Fractures in Clinical Practice: a Database Analysis Study. Curr Med Res Opin. 2006;22(9):1757-64. PubMed PMID: 16968579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. AU - van den Boogaard,C H A, AU - Breekveldt-Postma,N S, AU - Borggreve,S E, AU - Goettsch,W G, AU - Herings,R M C, PY - 2006/9/14/pubmed PY - 2007/1/12/medline PY - 2006/9/14/entrez SP - 1757 EP - 64 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 22 IS - 9 N2 - INTRODUCTION: International guidelines on the treatment and prevention of osteoporosis recommend the use of bisphosphonates to prevent fractures in this population. However, low persistent use of bisphosphonates could considerably limit the prevention of fractures in clinical practice. OBJECTIVE: This study aimed to investigate the association between persistent use of bisphosphonates and the risk of osteoporotic fractures in clinical practice. METHODS: Data were obtained from the PHARMO Record Linkage System, which includes, among other databases, drug-dispensing records from community pharmacies linked to hospital discharge records of more than two million subjects in defined areas in the Netherlands. Persistence with bisphosphonate therapy was assessed during a period of 3 years. A nested matched case control study (cases:controls = 1:10) was performed to study the association between persistent bisphosphonate use and hospitalisation for osteoporotic fractures and analysed by conditional logistic regression analysis. The analyses were adjusted for patient characteristics such as previous hospitalisations for fractures, co-morbidity and co-medication. RESULTS: 14,760 new female users of bisphosphonates were identified of which 541 women had a hospitalisation for osteoporotic fracture after start of bisphosphonate treatment (1-3 years follow-up). One-year persistence rates increased from 33% with alendronate daily to 48% with alendronate weekly, an increase of 15%. Similar results were obtained with risedronate daily and weekly. One year persistent use of bisphosphonates resulted in a statistical significant 26% lower fracture rate (OR 0.74; 95%CI 0.57-0.95) whereas 2 year persistent use resulted in a 32% lower rate (OR 0.68; 95%CI 0.47-0.96). CONCLUSIONS: Persistent use of bisphosphonates decreases the risk of osteoporotic fractures in clinical practice. Approximately 6% of fractures among users of bisphosphonates could be prevented if persistence was improved by 20%. However, current persistence with bisphosphonate therapy is suboptimal and strategies that further increase persistence are likely to further prevent the number of fractures. SN - 0300-7995 UR - https://www.unboundmedicine.com/medline/citation/16968579/Persistent_bisphosphonate_use_and_the_risk_of_osteoporotic_fractures_in_clinical_practice:_a_database_analysis_study_ L2 - https://www.tandfonline.com/doi/full/10.1185/030079906X132370 DB - PRIME DP - Unbound Medicine ER -