Abstract
Summary
Concerns have been raised over the association between bisphosphonates and atypical fractures in subtrochanteric and femoral shaft regions, but the potential risk of these fractures due to bisphosphonate use in asthma has not been examined.
Introduction
Bisphosphonates are used as first-line treatment for osteoporosis; however, concerns have been raised over their association with atypical subtrochanteric (ST) and femoral shaft (FS) fractures. The potential risk of atypical ST/FS fractures from bisphosphonate use in asthma has not been examined.
Methods
A nested case–control study was conducted using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we identified patients with atypical ST/FS fractures and sex, age, and practice-matched controls. Conditional logistic regression was used to determine the association between bisphosphonate exposure and atypical ST/FS fractures.
Results
From a cohort of 69,074 people with asthma, 67 patients with atypical ST/FS fractures and 260 matched control subjects were identified. Of the case patients, 40.3% had received bisphosphonates as compared with 14.2% of the controls corresponding to an adjusted odds ratio (aOR) of 4.42 (95%CI, 2.98 to 8.53). The duration of use influenced the risk with long-term users to be at a greater risk (> 5 years vs no exposure; aOR = 7.67; 95%CI, 1.75 to 33.91). Drug withdrawal was associated with diminished odds of atypical ST/FS fractures.
Conclusion
Regular review of bisphosphonates should occur in patients with asthma. The risks and benefits of bisphosphonate therapy should be carefully considered in consultation with the patient. To improve AFF prevention, early signs which may warrant imaging, such as prodromal thigh pain, should be discussed.
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Data availability
Data may be obtained from a third party and are not publicly available. This study is based on Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) data and is subject to a full license agreement which does not permit data sharing outside of the research team. However, data can be obtained by applying to CPRD (enquiries@cprd.com) for any replication of the study. The Read and ICD-10 codes used are available from the corresponding author upon reasonable request.
References
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Funding
The study was funded by the James Trust Research Grant, a research award from British Medical Association (RB48DR).
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The study was approved by the Independent Scientific Advisory Group of the CPRD (ISAC protocol number 19_041RA).
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Chalitsios, C.V., Shaw, D.E. & McKeever, T.M. Risk of subtrochanteric and femoral shaft fractures due to bisphosphonate therapy in asthma: a population-based nested case–control study. Osteoporos Int 33, 931–935 (2022). https://doi.org/10.1007/s00198-021-06197-7
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DOI: https://doi.org/10.1007/s00198-021-06197-7