Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study

ABSTRACT 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...

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Bibliographic Details
Published in:Current medical research and opinion 2006-09, Vol.22 (9), p.1757-1764
Main Authors: van den Boogaard, C. H. A., Breekveldt‐Postma, N. S., Borggreve, S. E., Goettsch, W. G., Herings, R. M. C.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Bisphosphonates
Case-Control Studies
Diphosphonates - administration & dosage
Dosing regimen
Drug Administration Schedule
Female
Fractures
Fractures, Bone - epidemiology
Fractures, Bone - etiology
Fractures, Bone - prevention & control
Humans
Middle Aged
Netherlands - epidemiology
Osteoporosis
Osteoporosis - complications
Osteoporosis - drug therapy
Osteoporosis - epidemiology
Persistence
Post-menopausal
Risk Factors
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Summary:ABSTRACT 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.
ISSN:0300-7995
1473-4877
DOI:10.1185/030079906X132370