Association of bisphosphonate therapy with incident lower extremity fractures in persons with spinal cord injuries/disorders
Abstract
OBJECTIVE
To investigate the association between prescriptions for bisphosphonates, calcium/Vitamin D supplements, and receipt of DXA screening, and incident fracture risk in men and women with a spinal cord injury/disorder (SCI/D).
DESIGN
Propensity matched case control analyses.
SETTING
U.S. Veterans Affairs facilities.
PARTICIPANTS
7,989 men and 849 women with a SCI/D included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified. Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to four controls.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURES
Incident lower extremity fractures.
RESULTS
There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (OR 1.04, 95% CI: 0.62-1.77) or women (OR 1.02, 95% CI 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR 1.25, 95% CI: 0.73-2.16), were concomitant users of Vitamin D/calcium and a bisphosphonate (OR 1.05 95% CI: 0.57-1.96), had more than one fracture on different dates during the study period (OR 0.13, 95% CI: 0.02-1.16) and in those who had undergone dual-energy x-ray absorptiometry (DXA) testing prior to the date of the bisphosphonate prescription and incident fracture (OR 1.26, 95% CI: 0.69-2.32).
CONCLUSIONS
In men with a traumatic SCI and women with a traumatic SCI or disorder, bisphosphonate therapies for…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 7,989 participants or records.
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