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Bisphosphonates Use and Risk of Subtrochanteric and Diaphyseal Femur Fractures in Korea: Results from the National Claim Registry

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Abstract

Although Asian with bisphosphonate has been considered to have higher risk of subtrochanteric and diaphyseal femur (ST/DF) fractures, the occurrence of those fractures has been still unclear in Asia. The purpose of this study was to investigate the incidence rate of ST/DF fractures among bisphosphonate users from nationwide database in South Korea. Using national health insurance claim database, we only included the bisphosphonate users who took bisphosphonate for the first time in 2008 and evaluated the incidence rate of ST/DF fracture from 2008 to 2013. Non-user controls were matched to bisphosphonate users by propensity score matching with age and gender. Cox regression models were used to calculate hazard ratios of ST/DF fracture with and without adjustment for comorbidity. A total of 682 ST/DF fractures were observed among 348,311 bisphosphonate users. The incidence rate of ST/DF fracture among bisphosphonate users (37.75/100,000 person years, 95% CI 35.02–40.70) was higher compared with non-users (24.41/100,000 person years, 95% CI 22.31–26.71). The risk of ST/DF fracture was greater in bisphosphonate users compared with non-users (hazard ratio 1.541, 1.370–1.734; p < 0.001). The incidence rate of ST/DF fracture after bisphosphonate use could be determined in Korean patients, which can provide basal information for further studies on risk and benefit of continuing bisphosphonate.

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Acknowledgements

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Korea (Grant Number: HI13C1522).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Young-Kyun Lee

  2. Department of Endocrinology, Internal Medicine, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea

    Dong Won Byun

  3. Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Sung-Mok Jung

  4. Department of Biology & Public Health, Mokwon University, Daejeon, Republic of Korea

    Hye-Young Kwon

  5. Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea

    Ha-Young Kim

  6. Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea

    Se Hwa Kim

  7. Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea

    Tae-Young Kim

  8. College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea

    Sunmee Jang

  9. Department of Orthopaedic Surgery, School of Medicine, Chung-Ang University, Seoul, Republic of Korea

    Yong-Chan Ha

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Contributions

Y-KL, DWB, H-YK, H-YK, SHK, T-YK, SJ, and Y-CH designed the study. Y-KL, DWB, S-MJ, H-YK, H-YK, SHK, T-YK, and SJ contributed to the acquisition, analysis, or interpretation of data. Y-KL, DWB, S-MJ, H-YK, H-YK, T-YK, and Y-CH prepared the first draft of the manuscript. Y-KL, DWB, S-MJ, H-YK, H-YK, SHK, T-YK, SJ, and Y-CH contributed to the critical revision of the manuscript for important intellectual content. Y-KL, DWB, S-MJ, H-YK, H-YK, SHK, SJ, and Y-CH were responsible for statistical analysis of the data. Y-KL, S-MJ, H-YK, SHK, T-YK, SJ, and Y-CH contributed to the administrative, technical, or material support. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved.

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Correspondence to Dong Won Byun or Tae-Young Kim.

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Conflict of interest

Young-Kyun Lee, Dong Won Byun, Sung-Mok Jung, Hye-Young Kwon, Ha-Young Kim, Se Hwa Kim, Tae-Young Kim, Sunmee Jang, and Yong-Chan Ha declare that they have no conflict of interest.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patient consent was not obtained because patient records/information were anonymized and de-identified prior to analysis.

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Lee, YK., Byun, D.W., Jung, SM. et al. Bisphosphonates Use and Risk of Subtrochanteric and Diaphyseal Femur Fractures in Korea: Results from the National Claim Registry. Calcif Tissue Int 104, 313–319 (2019). https://doi.org/10.1007/s00223-018-0493-2

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