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Long-term persistence with anti-osteoporosis drugs after fracture
Summary Long-term persistence with anti-osteoporosis drugs and determinants for discontinuation among fracture patients were examined. Persistence was 75.0 and 45.3 % after 1 and 5 years, respectively. Those aged ≥80 years were at increased risk of early discontinuation. Within 1 year after disconti...
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Published in: | Osteoporosis international 2015-06, Vol.26 (6), p.1831-1840 |
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Main Authors: | , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Summary
Long-term persistence with anti-osteoporosis drugs and determinants for discontinuation among fracture patients were examined. Persistence was 75.0 and 45.3 % after 1 and 5 years, respectively. Those aged ≥80 years were at increased risk of early discontinuation. Within 1 year after discontinuation, 24.3 % restarted therapy, yet 47.0 % persisted for 1 year.
Introduction
The risk of osteoporotic fracture can effectively be reduced with use of anti-osteoporosis drugs. However, little is known about persistence with these drugs after fracture where subsequent fracture risk is high. The aims were to determine long-term persistence with anti-osteoporosis drugs among fracture patients, including its determinants, and to describe restart and subsequent persistence.
Methods
A cohort study was conducted within the Dutch PHARMO Database Network. Patients aged ≥50 years (
n
= 961) who received anti-osteoporosis drugs within 1 year after fracture, but not in the preceding year, were included (2002–2011). Persistence (defined as the proportion on treatment) and the proportion restarting after discontinuation were estimated using Kaplan-Meier analyses. Time-dependent Cox regression was used to identify determinants of non-persistence including age, sex, initial dosage regime, fracture type, comorbidities, and drug use.
Results
Persistence with anti-osteoporosis drugs was 75.0 % (95 % confidence interval (CI) 72.0–77.7) and 45.3 % (95 % CI 40.4–50.0) after 1 and 5 years, respectively. A significant determinant of non-persistence was age ≥80 years (reference 50–59 years: adjusted hazard ratio [adj. HR] 1.65; 95 % CI 1.15–2.38). This effect was not constant over time (≤360 days following initiation: adj. HR 2.07; 95 % CI 1.27–3.37; >360 days: adj. HR 1.08; 95 % CI 0.62–1.88). Within 1 year after discontinuation, 24.3 % (95 % CI 20.1–29.2) restarted therapy, yet 47.0 % persisted for 1 year.
Conclusions
This study identified suboptimal persistence with anti-osteoporosis drugs among fracture patients. Major target groups for measures aimed to improve persistence may be those aged >80 years and those restarting therapy. |
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ISSN: | 0937-941X 1433-2965 |
DOI: | 10.1007/s00198-015-3084-3 |