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Time trends in oral bisphosphonate initiation in Ontario, Canada over 20 years reflect drug policy and healthcare delivery changes

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Abstract

Summary

Characteristics of patients starting oral bisphosphonate therapy changed over time, reflecting trends in osteoporosis management (e.g., new drugs to market), and general healthcare delivery (e.g., benzodiazepine use declined, statin use increased). When designing studies that examine osteoporosis drug effects, potential time-related biases must be considered.

Introduction

To describe the type of oral bisphosphonate initiated and characteristics of patients starting oral bisphosphonate therapy over time.

Methods

We identified community-dwelling older adults (ages ≥ 66 years) initiating oral bisphosphonate therapy from April 1996 to March 2016 (1996 to 2015 fiscal years) using healthcare administrative data in Ontario. Patients with conditions other than osteoporosis that may impact bisphosphonate prescribing were excluded. The bisphosphonate initiated and patient characteristics were summarized by fiscal year and stratified by sex.

Results

We identified 560,817 eligible patients (81% women). Most patients initiated cyclical etidronate from 1996 until 2005, and then weekly regimens became dominant. In 2008, risedronate became the main oral bisphosphonate (46% risedronate, 43% alendronate, 11% etidronate); with its use increasing after availability of monthly and delayed-release risedronate formulations. In 2015, 71% of patients started risedronate, 28% started alendronate, and less than 2% started etidronate. Characteristics of patients changed over time, reflecting changes in osteoporosis management and general healthcare delivery. Over time, a larger proportion of men (9% to 28%) and patients with diabetes (women 10% to 17%, men 14% to 22%) initiated therapy; benzodiazepine (women 22% to 13%, men 20% to 10%) and estrogen-based hormone replacement therapy (12% to 15% of women 1996–2002 to 3% since 2008) decreased, while statin use increased (women 15% to 39%, men 14% to 52%).

Conclusions

The characteristics of patients starting oral bisphosphonate therapy have changed over time. Consideration must be given to these time trends when designing studies that examine osteoporosis drug effects.

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Funding

This research was supported, in part, by Canadian Institutes of Health Research Drug Safety and Effectiveness Cross-Disciplinary Training Program Stream 1 Trainee Awards to Kaleen Hayes and Joann Ban. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institutes of Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the author(s) and not necessarily those of CIHI. We thank IMS Brogan Inc. for use of their Drug Information Database. All analyses were completed at the ICES University of Toronto site, supported by the Leslie Dan Faculty of Pharmacy.

Author information

Authors and Affiliations

  1. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    K.N. Hayes & S.M. Cadarette

  2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    J.K. Ban, G. Athanasiadis & S.M. Cadarette

  3. Department of Chemistry and Applied Biosciences, ETH Zürich, Institute of Pharmaceutical Sciences, Zürich, Switzerland

    A.M. Burden

  4. Department of Clinical Pharmacology and Toxicology, University Hospital and University of Zurich, Zurich, Switzerland

    A.M. Burden

  5. ICES, Toronto, ON, Canada

    S.M. Cadarette

  6. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA

    S.M. Cadarette

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  1. K.N. Hayes
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Correspondence to S.M. Cadarette.

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This study was approved by the Research Ethics Boards at Sunnybrook Health Sciences Centre in Toronto and the University of Toronto.

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Hayes, K., Ban, J., Athanasiadis, G. et al. Time trends in oral bisphosphonate initiation in Ontario, Canada over 20 years reflect drug policy and healthcare delivery changes. Osteoporos Int 30, 2311–2319 (2019). https://doi.org/10.1007/s00198-019-05061-z

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