Risedronate discontinuation may increase mortality risk after hip fracture
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Key takeaways:
- Older adults who stop using risedronate after at least 5 years of treatment have an increased mortality risk after a hip fracture.
- Alendronate discontinuation was not linked to a higher risk for death.
Older adults who sustain a hip fracture after discontinuing risedronate following at least 5 years of treatment adherence have a higher post-fracture mortality risk than those who continue using risedronate, according to study data.
In a retrospective cohort study conducted in Australia, researchers compared post-fracture mortality risk for older adults who stop using oral bisphosphonates with those who continued bisphosphonate use in the years leading up to a fracture. Researchers found no link between discontinuing alendronate and post-fracture mortality risk, but adults who stopped using risedronate for 1 year or more had a higher risk for mortality after a hip fracture.
“Our results suggest the effects of discontinuing risedronate and alendronate are different, and the type of bisphosphonate may be a factor to consider when planning drug holidays for different types of bisphosphonates,” Miriam T.Y. Leung, BPharm, MClinPharm, a PhD student in the Centre for Medication Use and Safety at Monash University in Melbourne, told Healio.
Leung and colleagues analyzed data from 365 adults aged 50 years and older who were hospitalized with a hip fracture from July 2014 to June 2018 in the state of Victoria in Australia (87.9% women). Participants had data available in Australia’s Pharmaceutical Benefits Scheme database on oral bisphosphonate use for 8 years before sustaining a fracture. Participants were required to adhere to at least 80% of their prescribed bisphosphonate therapy in the first 5 years of the 8-year pre-fracture period and receive at least one bisphosphonate prescription in the 3 years before their fracture to be included in the study. Mortality data were obtained from Australia’s National Death Index.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
Of the study group, 212 adults were prescribed alendronate and 153 used risedronate. In the 3 years before their hip fracture, 68.8% of participants continued bisphosphonate use, 17.5% discontinued use for 1 year and 13.7% discontinued bisphosphonates for 2 years.
During a median follow-up of 19 months, 38.2% of adults prescribed alendronate and 37.9% of those prescribed risedronate died after a hip fracture. Adults who discontinued alendronate for 1 or 2 years had a similar mortality risk as those who continued therapy. Adults who discontinued risedronate for 1 year (HR = 2.37; 95% CI, 1.24-4.53) or 2 years (HR = 3.08; 95% CI, 1.48-6.41) had a higher risk for death after a hip fracture than those who continued therapy.
“Risedronate may have a quicker offset of action while alendronate may be retained longer in the body,” Leung said. “The quicker offset may translate into extraskeletal effects and fracture sequelae, reflected in the higher post-fracture mortality found in our study.”
The findings were similar in a sensitivity analysis of 902 adults who had 3 years of 80% or higher medication adherence 5 to 2 years before fracture. Adults prescribed risedronate who discontinued use for 1 year had a higher risk for mortality than adults who continued treatment (HR = 1.66; 95% CI, 1.01-2.73). No increased risk for death was observed among adults prescribed alendronate or those who discontinued risedronate for less than 1 year.
“Further research is needed in a larger population to confirm the results and with longer follow-up to assess the effect of discontinuing alendronate for a longer period of time,” Leung said.
For more information:
Miriam T.Y. Leung, BPharm, MClinPharm, can be reached at miriam.leung77@monash.edu.
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