Predictors of fracture while on treatment with oral bisphosphonates: a population-based cohort study
Abstract
Although oral bisphosphonates (BPs) are highly effective in preventing fractures, some patients will fracture while on treatment. We identified predictors of such fractures in a population‐based cohort of incident users of oral BPs. We screened the Sistema d‘Informació per al Desenvolupament de l‘Investigació en Atenció Primària (SIDIAP) database to identify new users of oral BPs in 2006–2007. SIDIAP includes pharmacy invoice data and primary care electronic medical records for a representative 5 million people in Catalonia (Spain). Exclusion criteria were the following: Paget disease; 6 months of therapy. Incidence of fracture while on treatment was 3.4/100 person‐years (95% confidence interval [CI], 3.1–3.7). Predictors of these among patients persisting and adhering to treatment included: older age (subhazard ratio [SHR] for 60 to <80 years, 2.18 [95% CI, 1.70–2.80]; for ≥80 years, 2.5 [95% CI, 1.82–3.43]); previous fracture (1.75 [95% CI, 1.39–2.20] and 2.49 [95% CI, 1.98–3.13], in the last 6 months and longer, respectively); underweight, 2.11 (95% CI, 1.14–3.92); inflammatory arthritis, 1.46 (95% CI, 1.02–2.10); use of proton pump inhibitors (PPIs), 1.22 (95% CI, 1.02–1.46); and vitamin D deficiency, 2.69 (95% CI, 1.27–5.72). Even among high compliers, 3.4% of oral BP users will fracture every year. Older age, underweight, vitamin D deficiency, PPI use, previous fracture, and inflammatory arthritides increase risk. Monitoring strategies and/or alternative therapies…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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