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One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study

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Adherence to anti-osteoporosis medications is poor. We carried out a cohort study using a real-world population database to estimate the persistence of anti-osteoporosis drugs. Unadjusted 2-year persistence ranged from 10.3 to 45.4%. Denosumab users had a 40% lower risk of discontinuation at 2 years compared to alendronate users.


The purpose of this study was to estimate real-world persistence amongst incident users of anti-osteoporosis medications.


This is a retrospective cohort using data from anonymised records and dispensation data ( Eligibility comprised the following: women aged ≥50, incident users of anti-osteoporosis medication (2012), with data available for at least 12 months prior to therapy initiation. Exclusions are other bone diseases/treatments and uncommon anti-osteoporosis drugs (N < 100). Follow-up was from first pharmacy dispensation until cessation, end of study, censoring or switching. Outcomes are 2- and 1-year persistence with a permissible gap of up to 90 days. Persistence with alendronate was compared to other bisphosphonates, strontium ranelate, selective oestrogen receptor modulators, teriparatide and denosumab. Cox models were used to estimate hazard ratios of therapy cessation according to drug used after adjustment for age, sex, BMI, smoking, alcohol drinking, Charlson co-morbidity index, previous fractures, use of anti-osteoporosis medication/s, oral corticosteroids and socio-economic status.


A total of 19,253 women were included. Unadjusted 2-year persistence [95% CI] ranged from 10.3% [9.1–11.6%] (strontium ranelate) to 45.4% [43.1–47.8%] (denosumab). One-year persistence went from 35.8% [33.9%–37.7%] (strontium ranelate) to 65.8% [63.6%–68.0%] (denosumab). At the end of the first year and compared to alendronate users, both teriparatide and denosumab users had reduced cessation risk (adjusted HR 0.76, 95% CI 0.67–0.86 and 0.54, 95% CI 0.50–0.59 respectively) while at the end of the second year, only denosumab had a lower risk of discontinuation (adjusted HR 0.60, 95% CI 0.56–0.64).


Unadjusted 2-year persistence is suboptimal. However, both teriparatide and denosumab users had better 1-year persistence and only denosumab had 2-year better persistence compared to alendronate users. Unmeasured confounding by indication might partially explain our findings.

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We thank all the health professionals involved in registering data in computerised medical records for SIDIAP (Information System for Development of Primary Care Research). We thank as well Francisco Sorio Vilela and Laura Canals from Amgen for their contribution. Amgen provided comments on the design of the study protocol and the analysis plan. The final protocol and analysis plan were mutually agreed by SIDIAP and Amgen, based on the principle of the “best science known in the research field.” Amgen also provided comments on the publication prior to its submission to the journal. However, SIDIAP alone decided whether to incorporate Amgen comments in the submitted publication. Co-funded with FEDER funding.

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Correspondence to D. Prieto-Alhambra.

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Ethical approval

Scientific approval was obtained from the SIDIAP Scientific Committee, and ethics approval was granted by the relevant board (CEIC IDIAP Jordi Gol). 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.

Informed consent

For this type of study, formal consent is not required.

Conflict of interest

DPA’s research team has received unrestricted research funding from Bioiberica, Amgen and Servier Laboratoires; DPA’s department has received fees for speaker services from Amgen. C.T reports personal fees from Fundació Jordi Gol i Gurina, during the conduct of the study, and personal fees from Boehringer Ingelheim, outside the submitted work. DML reports fees for speaker or consultant services from Amgen, Lilly, MSD and Servier. CR, ASC, CCA and MSA report no conflict of interest.


Unrestricted research grant from Amgen. Partial funding of researchers (DPA) from NIHR Musculoskeletal Biomedical Research Unit Oxford, University of Oxford, UK.

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Reyes, C., Tebe, C., Martinez-Laguna, D. et al. One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study. Osteoporos Int 28, 2997–3004 (2017).

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