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Risk factors for fracture among current, persistent users of bisphosphonates

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Abstract

Summary

Bisphosphonate therapy reduces fracture risk but does not eliminate fracture occurrence. We determined the fracture incidence and risk factors for fractures among 14,674 bisphosphonate users in a community setting. Bisphosphonate users remained at risk of fracture, and additional measures to prevent fractures in these patients would be beneficial.

Introduction

Bisphosphonate therapy reduces but does not eliminate fracture occurrence. The incidence of fracture and risk factors for fractures among persistent, current users of bisphosphonates in a community setting have not been well studied.

Methods

We conducted a retrospective cohort study of 14,674 bisphosphonate users in a health maintenance organization. Patients were followed until a 3-month gap in therapy, creating a pool of highly compliant [mean medication possession ratio (MPR) of 94 %] current users. We used Cox proportional hazards models to identify risk factors for fractures among these persistent, current users.

Results

There were 867 fractures over the period of observation or 3.7 fractures per 100 users per year. Older patients who take multiple medications, have lower bone mineral density, have a history of prior fracture, and suffer from particular comorbidities (i.e., dementia, chronic kidney disease, and rheumatoid arthritis) are at higher risk of fracture while taking bisphosphonates.

Conclusion

Persistent, current bisphosphonate users remain at risk of fracture, and additional measures to prevent fractures in these patients would be of benefit.

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Acknowledgments

Elizabeth Sheeley assisted with manuscript preparation. This study was funded by Amgen, Inc.

Conflicts of interest

This study was funded by Amgen, Inc. Dr. LeBlanc has received additional research funding from BMS and Astrazenca for an unrelated project. Drs. Balasubramanian, O’Malley, and Egbuna are employees of Amgen. Dr. Friess has received consulting fees from Accemed, LLC. Ms Rosales and Dr. Perrin have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA

    E. S. LeBlanc, A. G. Rosales & N. A. Perrin

  2. Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA

    A. Balasubramanian, C. D. O’Malley & O. Egbuna

  3. OHSU, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    D. Friess

Authors
  1. E. S. LeBlanc
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  2. A. G. Rosales
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  3. A. Balasubramanian
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  4. C. D. O’Malley
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  5. O. Egbuna
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  6. D. Friess
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  7. N. A. Perrin
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Corresponding author

Correspondence to E. S. LeBlanc.

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LeBlanc, E.S., Rosales, A.G., Balasubramanian, A. et al. Risk factors for fracture among current, persistent users of bisphosphonates. Osteoporos Int 26, 713–725 (2015). https://doi.org/10.1007/s00198-014-2941-9

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  • DOI: https://doi.org/10.1007/s00198-014-2941-9

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