Archives of Osteoporosis

, 13:113 | Cite as

Impact of bisphosphonate compliance on the risk of osteoporotic fracture in France

  • Manon BelhassenEmail author
  • Bernard Cortet
  • Cyrille B. Confavreux
  • Liliane Lamezec
  • Marine Ginoux
  • Eric Van Ganse
Original Article



Limited information is available on the impact of bisphosphonate compliance levels on fracture risk in osteoporosis patients in France. The results of this nested case-control, retrospective study suggest that fracture risk did not significantly change with bisphosphonate compliance levels, except for highly compliant patients.


This was the first study conducted in France to evaluate the impact of compliance levels for bisphosphonates, the most frequently prescribed first-line anti-osteoporotic treatment, on fracture risk.


This retrospective nested case-control study included patients ≥ 50 years old, who were recorded in a random sample of French claims data, did not die between 2006 and 2013, and received ≥ 1 reimbursement for anti-osteoporotic treatment between 2007 and 2013. Cases (patients hospitalised for osteoporosis-related fractures) were matched to 1–3 controls (patients hospitalised for other reasons). Patients hospitalised for fractures within 12 months preceding the first delivery of anti-osteoporotic treatment or during the first 24 months of follow-up were excluded. Bisphosphonate compliance during the 24 months preceding hospitalisation was calculated by the Continuous measure of Medication Acquisition version 7 (CMA7). We evaluated the impact of bisphosphonate compliance (CMA7 ≥ 80%) and very good compliance levels (CMA7 > 90%) on fracture risk.


In the main analysis, the mean CMA7 values during the 24 months preceding hospitalisation were 48.4% for the 434 cases and 51.3% for the 1123 age-matched controls. An adjusted conditional logistic regression showed no significant impact (odds ratio: 0.851 [95% confidence interval: 0.668, 1.084]) of bisphosphonate compliance on fracture occurrence. In the sensitivity analysis, including one randomly selected control per case and only controls with CMA7 values > 90%, occurrence of fractures was lower (odds ratio: 0.741 [95% confidence interval: 0.608, 0.903]) among the 119 controls.


In conclusion, this study suggested that very high levels of compliance with bisphosphonates are necessary to induce significant decreases in fracture risk.


Osteoporosis Treatment Epidemiology Outcomes research 



Bone mineral density


Continuous measure of Medication Acquisition version 7


Chronic obstructive pulmonary disease


Echantillon généraliste de bénéficiaires


International classification of diseases, 10th edition


Medication possession rate


Nonsteroidal anti-inflammatory drugs



We thank the French National Health Service (Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés) and the Institute of Health Data (Institut des Données de Santé) for providing data. The authors thank Claire Verbelen (XPE Pharma & Science, Wavre, Belgium) for professional medical writing support.

Author contributions

All authors critically reviewed the manuscript. E.V.G. obtained funding. E.V.G. and M.B. provided supervision, conceived and designed the study, interpreted the data, and drafted the manuscript. M.G. performed the statistical analysis. B.C. and C.B.C. conceived and designed the study and interpreted the data. L.L. contributed to study design and interpretation of data. M.B. is the guarantor of the study.


This study was funded by a non-conditional grant from MSD France.

Compliance with ethical standards

Conflicts of interest


Ethics approval and consent to participate

This observational study was conducted on anonymised claims data (EGB), and the National Informatics and Liberty Committee has delivered an overall authorisation to use EGB data for research purposes. This study was performed after approval by the Institute of Health Data (Institut des Données de Santé, approval 63, June 11, 2013).

Consent to publish

Not applicable.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Manon Belhassen
    • 1
    • 2
    Email author
  • Bernard Cortet
    • 3
  • Cyrille B. Confavreux
    • 4
  • Liliane Lamezec
    • 5
  • Marine Ginoux
    • 2
  • Eric Van Ganse
    • 1
    • 2
  1. 1.HESPER 7425, Health Services and Performance ResearchLyonFrance
  2. 2.PharmacoEpidemiology Lyon (PELyon)LyonFrance
  3. 3.Department of RheumatologyLille University HospitalLilleFrance
  4. 4.INSERM UMR 1033, Rheumatology DepartmentUniversity of LyonLyonFrance
  5. 5.Merck Sharp & DohmeParisFrance

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