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Time to benefit and the long-term persistence of new users of oral bisphosphonates

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Abstract

Introduction

This study aimed to examine long-term persistence in new users of oral bisphosphonates in a population-wide cohort in Manitoba, Canada.

Materials and methods

A longitudinal observational study was conducted using administrative health data characterizing long-term bisphosphonate persistence in those who started treatment between 1997 and 2018. Treatment discontinuation was evaluated using Kaplan–Meier methods. Cox regression was used to examine associations between discontinuation and osteoporosis diagnosis, previous fractures, and age. A sub-analysis of users with FRAX scores examined the relationship between 10-year fracture risk estimations and discontinuation.

Results

Of 42,249 new bisphosphonate users, median age was 71 years, with 88.6% being female. Median duration of bisphosphonate use was 0.95 years (IQR 0.25, 3.9 years). Overall, 47.9% of incident users persisted up to 1 year, 25.0% persisted up to 3 years, and 14.1% up to 5 years. Presence of an indication for bisphosphonate use was associated with decreased discontinuation risk. Persistence generally increased with age. Having a BMD test performed was a predictor of lower discontinuation. The strongest predictor was having an osteoporosis diagnosis [HR for discontinuation = 0.68 (95% CI 0.66, 0.70)]. In users with FRAX scores (n = 14,114), moderate-risk [HR = 0.86 (95% CI 0.77, 0.96)] and high-risk users [HR = 0.77 (95% CI 0.69, 0.85)] were less likely to discontinue compared to lower-risk users.

Conclusions

A rapid decline in bisphosphonate persistence was shown. Almost half of users would not be expected to achieve clinically relevant benefits with a persistence of less than 1 year. Allowing informed choice in high-risk patients may be the best way to focus on those likely to benefit and persist with treatment.

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under project #H2016:16 (HIPC# 2016/2017-05). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Senior and Active Living, or other data providers is intended or should be inferred. Data used in this study are from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by Manitoba Health, Seniors and Active Living and the Manitoba Centre for Health Policy, University of Manitoba and were derived from data provided by Manitoba.

Funding

This study was funded by a University of Manitoba internal grant.

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Authors and Affiliations

  1. College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada

    Kevin J. Friesen, Shawn Bugden & Jamie Falk

  2. School of Pharmacy, Memorial University, St. John’s, NL, Canada

    Shawn Bugden

Authors
  1. Kevin J. Friesen
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  2. Shawn Bugden
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  3. Jamie Falk
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Contributions

All authors (KJF, SB, and JF) contributed to the study design, analysis of the data, and writing and review of the final manuscript. KJF provided additional analytical and statistical support.

Corresponding author

Correspondence to Jamie Falk.

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All authors have no conflicts of interest.

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Friesen, K.J., Bugden, S. & Falk, J. Time to benefit and the long-term persistence of new users of oral bisphosphonates. J Bone Miner Metab 38, 371–377 (2020). https://doi.org/10.1007/s00774-019-01069-x

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  • DOI: https://doi.org/10.1007/s00774-019-01069-x

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