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Bisphosphonate and denosumab initiation in older adults in Ontario, Canada: a population-based cohort study.
Arch Osteoporos. 2020 08 20; 15(1):133.AO

Abstract

We provide an update on how commonly prescribed osteoporosis therapies are being initiated in older adults in Ontario. Patients newly prescribed denosumab are older, more often female, and have more comorbidities than those prescribed bisphosphonates. Their characteristics, monitoring, and persistence with prescribed therapy differ from clinical trial participants. Real-world studies on oral bisphosphonates and denosumab might be valuable.

PURPOSE

To provide a contemporary view on oral bisphosphonate and denosumab prescribing to older adults in routine care.

METHODS

Using linked healthcare databases, we conducted a population-based cohort study of adults ≥ 66 years newly prescribed oral bisphosphonates or denosumab between February 2013 and March 2017 in Ontario, Canada. We captured their clinical characteristics, monitoring, and continuous use of prescribed therapies. We illustrate how "real-world" new users of bisphosphonates and denosumab differ from randomized controlled trial (RCT) participants.

RESULTS

There were 107,847 individuals newly prescribed oral bisphosphonates (n = 59,996) or denosumab (n = 47,851) over the study period. Compared with new users of oral bisphosphonates, denosumab users were older (mean age 79.1 vs. 75.7 years), more often female (97.2 vs. 71.8%), from non-rural areas (93.9 vs. 89.9%), and resided in long-term care (10.9 vs. 3.3%). They had more comorbidities including dementia, falls, and fractures. Following their new prescription, denosumab users had more frequent testing of serum calcium. Duration of continuous use of denosumab was longer than bisphosphonates, and more bisphosphonate users had evidence of treatment discontinuation (56.7 bisphosphonate vs. 33.8% denosumab users discontinued therapy at 365 days). Compared with RCT participants, a higher proportion of "real-world" bisphosphonate and denosumab users had comorbidities including advanced kidney disease.

CONCLUSION

The clinical characteristics and monitoring of new users of bisphosphonates and denosumab generally align with practice guidelines, product monographs, and drug reimbursement criteria. Given differences between real-world users and RCT participants, there may be a role for safety and effectiveness studies of bisphosphonates and denosumab in routine care.

Authors+Show Affiliations

Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada. kristin.clemens@sjhc.london.on.ca. Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. kristin.clemens@sjhc.london.on.ca. ICES, Ontario, Canada. kristin.clemens@sjhc.london.on.ca. Lawson Health Research Institute, London, Ontario, Canada. kristin.clemens@sjhc.london.on.ca. Center for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, Canada. kristin.clemens@sjhc.london.on.ca.ICES, Ontario, Canada.ICES, Ontario, Canada.Department of Medicine, Division of Geriatrics, Western University, London, Ontario, Canada.Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada. Center for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, Canada.

Pub Type(s)

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

Language

eng

PubMed ID

32816151

Citation

Clemens, Kristin K., et al. "Bisphosphonate and Denosumab Initiation in Older Adults in Ontario, Canada: a Population-based Cohort Study." Archives of Osteoporosis, vol. 15, no. 1, 2020, p. 133.
Clemens KK, Jeyakumar N, Ouédraogo AM, et al. Bisphosphonate and denosumab initiation in older adults in Ontario, Canada: a population-based cohort study. Arch Osteoporos. 2020;15(1):133.
Clemens, K. K., Jeyakumar, N., Ouédraogo, A. M., Thain, J., & Khan, T. (2020). Bisphosphonate and denosumab initiation in older adults in Ontario, Canada: a population-based cohort study. Archives of Osteoporosis, 15(1), 133. https://doi.org/10.1007/s11657-020-00796-3
Clemens KK, et al. Bisphosphonate and Denosumab Initiation in Older Adults in Ontario, Canada: a Population-based Cohort Study. Arch Osteoporos. 2020 08 20;15(1):133. PubMed PMID: 32816151.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bisphosphonate and denosumab initiation in older adults in Ontario, Canada: a population-based cohort study. AU - Clemens,Kristin K, AU - Jeyakumar,Nivethika, AU - Ouédraogo,Alexandra M, AU - Thain,Jenny, AU - Khan,Tayyab, Y1 - 2020/08/20/ PY - 2020/04/30/received PY - 2020/07/21/accepted PY - 2020/8/21/entrez PY - 2020/8/21/pubmed PY - 2020/11/3/medline KW - Bisphosphonates KW - Characteristics KW - Denosumab KW - New use KW - Persistence SP - 133 EP - 133 JF - Archives of osteoporosis JO - Arch Osteoporos VL - 15 IS - 1 N2 - : We provide an update on how commonly prescribed osteoporosis therapies are being initiated in older adults in Ontario. Patients newly prescribed denosumab are older, more often female, and have more comorbidities than those prescribed bisphosphonates. Their characteristics, monitoring, and persistence with prescribed therapy differ from clinical trial participants. Real-world studies on oral bisphosphonates and denosumab might be valuable. PURPOSE: To provide a contemporary view on oral bisphosphonate and denosumab prescribing to older adults in routine care. METHODS: Using linked healthcare databases, we conducted a population-based cohort study of adults ≥ 66 years newly prescribed oral bisphosphonates or denosumab between February 2013 and March 2017 in Ontario, Canada. We captured their clinical characteristics, monitoring, and continuous use of prescribed therapies. We illustrate how "real-world" new users of bisphosphonates and denosumab differ from randomized controlled trial (RCT) participants. RESULTS: There were 107,847 individuals newly prescribed oral bisphosphonates (n = 59,996) or denosumab (n = 47,851) over the study period. Compared with new users of oral bisphosphonates, denosumab users were older (mean age 79.1 vs. 75.7 years), more often female (97.2 vs. 71.8%), from non-rural areas (93.9 vs. 89.9%), and resided in long-term care (10.9 vs. 3.3%). They had more comorbidities including dementia, falls, and fractures. Following their new prescription, denosumab users had more frequent testing of serum calcium. Duration of continuous use of denosumab was longer than bisphosphonates, and more bisphosphonate users had evidence of treatment discontinuation (56.7 bisphosphonate vs. 33.8% denosumab users discontinued therapy at 365 days). Compared with RCT participants, a higher proportion of "real-world" bisphosphonate and denosumab users had comorbidities including advanced kidney disease. CONCLUSION: The clinical characteristics and monitoring of new users of bisphosphonates and denosumab generally align with practice guidelines, product monographs, and drug reimbursement criteria. Given differences between real-world users and RCT participants, there may be a role for safety and effectiveness studies of bisphosphonates and denosumab in routine care. SN - 1862-3514 UR - https://www.unboundmedicine.com/medline/citation/32816151/Bisphosphonate_and_denosumab_initiation_in_older_adults_in_Ontario_Canada:_a_population_based_cohort_study_ L2 - https://dx.doi.org/10.1007/s11657-020-00796-3 DB - PRIME DP - Unbound Medicine ER -