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Women adherent to bisphosphonate therapy still at risk for fracture
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Women who were adherent to bisphosphonate therapy for at least 2 years remained at risk for fracture, with 7% sustaining osteoporotic fracture and 35% sustaining fracture, decreases in bone mineral density or persistent osteoporosis, according to research in Bone.
Erik A. Imel, MD, of Indiana University School of Medicine and the Regenstrief Institute in Indianapolis, and colleagues analyzed data from 7,435 women aged at least 50 years (mean age, 68 years; 77% white) who were adherent to oral bisphosphonate therapy (defined as a dispensed medication possession ratio 0.8) for at least 2 years. Using data from the Indiana Network for Patient Care, researchers analyzed incidents of low trauma fracture between months 7 and 36, a persistent T-score of –2.5 or less and decreases in BMD at any skeletal site of 5% or more.
Within the cohort, 3,110 women had DXA data from either 2 years before or 1 to 3 years after the adherence period. In the full cohort, 7% (n = 499) sustained an incident osteoporotic fracture; 2% (n = 174) experienced two or more distinct fracture events between months 7 and 36.
In the 601 women having both pre- and post-adherent DXA data to evaluate BMD change, 6% had fractures; 22% had a posttreatment T-score of –2.5 or greater, and 16% experienced a decrease in BMD of 5% or more.
Composite outcomes occurred in 35% of the cohort. Incident fracture was predicted by age, previous fracture and a variety of comorbidities, but not by race, glucocorticoid treatment or type of bisphosphonate, according to researchers.
“Despite adherence, a substantial proportion of patients in clinical practices treated with oral bisphosphonates remain at risk for fractures, and a third of patients had one of the suboptimal clinical outcomes,” the researchers wrote. “Although clinical trials have indicated a decrease in fracture risk even with declines in BMD during bisphosphonate therapy, the benefit achieved by such patients is not likely to be optimal.” – by Regina Schaffer
Disclosure: The research was funded by a grant under the Merck-Regenstrief Program, a collaboration between Merck, Sharp & Dohme and the Regenstrief Institute. Imel reports receiving research funding from Merck, Sharp & Dohme; two study researchers are employees of Merck, Sharp & Dohme.
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