Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

Erik Imel, George Eckert, Ankita Modi, Zhuokai Li, Joel Martin, Anne de Papp, Katie Allen, C. Conrad Johnston, Siu Hui, Ziyue Liu

Research output: Contribution to journalArticle

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Abstract

Background: Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture. Methods: A retrospective cohort of women aged 50. years and older, adherent to oral bisphosphonates for at least two years was identified, and data were extracted from a multi-system health information exchange. Adherence was defined as having a dispensed medication possession ratio. ≥ 0.8. The primary outcome was clinical occurrence of: low trauma fracture (months 7-36), persistent T-score. ≤ - 2.5 (months 13-36), decrease in bone mineral density (BMD) at any skeletal site. ≥ 5%, or the composite of any one of these outcomes. Results: Of 7435 adherent women, 3110 had either pre- or post-adherent DXA data. In the full cohort, 7% had an incident osteoporotic fracture. In 601 women having both pre- and post-adherent DXA to evaluate BMD change, 6% had fractures, 22% had a post-treatment T-score. ≤ - 2.5, and 16% had BMD decrease by ≥ 5%. The composite outcomes occurred in 35%. Incident fracture was predicted by age, previous fracture, and a variety of co-morbidities, but not by race, glucocorticoid treatment or type of bisphosphonate. Conclusion: Despite bisphosphonate adherence, 7% had incident osteoporotic fractures and 35% had either fracture, decreases in BMD, or persistent osteoporotic BMD, representing a substantial proportion of treated patients in clinical practices remaining at risk for future fractures. Further studies are required to determine the best achievable goals for osteoporosis therapy, and which patients would benefit from alternate therapies.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalBone
Volume83
DOIs
StatePublished - Feb 1 2016

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Diphosphonates
Bone Density
Osteoporotic Fractures
Therapeutics
Glucocorticoids
Osteoporosis
Morbidity
Wounds and Injuries

ASJC Scopus subject areas

  • Physiology
  • Endocrinology, Diabetes and Metabolism
  • Histology

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Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates. / Imel, Erik; Eckert, George; Modi, Ankita; Li, Zhuokai; Martin, Joel; de Papp, Anne; Allen, Katie; Johnston, C. Conrad; Hui, Siu; Liu, Ziyue.

In: Bone, Vol. 83, 01.02.2016, p. 267-275.

Research output: Contribution to journalArticle

Imel, Erik ; Eckert, George ; Modi, Ankita ; Li, Zhuokai ; Martin, Joel ; de Papp, Anne ; Allen, Katie ; Johnston, C. Conrad ; Hui, Siu ; Liu, Ziyue. / Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates. In: Bone. 2016 ; Vol. 83. pp. 267-275.
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abstract = "Background: Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture. Methods: A retrospective cohort of women aged 50. years and older, adherent to oral bisphosphonates for at least two years was identified, and data were extracted from a multi-system health information exchange. Adherence was defined as having a dispensed medication possession ratio. ≥ 0.8. The primary outcome was clinical occurrence of: low trauma fracture (months 7-36), persistent T-score. ≤ - 2.5 (months 13-36), decrease in bone mineral density (BMD) at any skeletal site. ≥ 5{\%}, or the composite of any one of these outcomes. Results: Of 7435 adherent women, 3110 had either pre- or post-adherent DXA data. In the full cohort, 7{\%} had an incident osteoporotic fracture. In 601 women having both pre- and post-adherent DXA to evaluate BMD change, 6{\%} had fractures, 22{\%} had a post-treatment T-score. ≤ - 2.5, and 16{\%} had BMD decrease by ≥ 5{\%}. The composite outcomes occurred in 35{\%}. Incident fracture was predicted by age, previous fracture, and a variety of co-morbidities, but not by race, glucocorticoid treatment or type of bisphosphonate. Conclusion: Despite bisphosphonate adherence, 7{\%} had incident osteoporotic fractures and 35{\%} had either fracture, decreases in BMD, or persistent osteoporotic BMD, representing a substantial proportion of treated patients in clinical practices remaining at risk for future fractures. Further studies are required to determine the best achievable goals for osteoporosis therapy, and which patients would benefit from alternate therapies.",
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T1 - Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

AU - Imel, Erik

AU - Eckert, George

AU - Modi, Ankita

AU - Li, Zhuokai

AU - Martin, Joel

AU - de Papp, Anne

AU - Allen, Katie

AU - Johnston, C. Conrad

AU - Hui, Siu

AU - Liu, Ziyue

PY - 2016/2/1

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N2 - Background: Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture. Methods: A retrospective cohort of women aged 50. years and older, adherent to oral bisphosphonates for at least two years was identified, and data were extracted from a multi-system health information exchange. Adherence was defined as having a dispensed medication possession ratio. ≥ 0.8. The primary outcome was clinical occurrence of: low trauma fracture (months 7-36), persistent T-score. ≤ - 2.5 (months 13-36), decrease in bone mineral density (BMD) at any skeletal site. ≥ 5%, or the composite of any one of these outcomes. Results: Of 7435 adherent women, 3110 had either pre- or post-adherent DXA data. In the full cohort, 7% had an incident osteoporotic fracture. In 601 women having both pre- and post-adherent DXA to evaluate BMD change, 6% had fractures, 22% had a post-treatment T-score. ≤ - 2.5, and 16% had BMD decrease by ≥ 5%. The composite outcomes occurred in 35%. Incident fracture was predicted by age, previous fracture, and a variety of co-morbidities, but not by race, glucocorticoid treatment or type of bisphosphonate. Conclusion: Despite bisphosphonate adherence, 7% had incident osteoporotic fractures and 35% had either fracture, decreases in BMD, or persistent osteoporotic BMD, representing a substantial proportion of treated patients in clinical practices remaining at risk for future fractures. Further studies are required to determine the best achievable goals for osteoporosis therapy, and which patients would benefit from alternate therapies.

AB - Background: Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture. Methods: A retrospective cohort of women aged 50. years and older, adherent to oral bisphosphonates for at least two years was identified, and data were extracted from a multi-system health information exchange. Adherence was defined as having a dispensed medication possession ratio. ≥ 0.8. The primary outcome was clinical occurrence of: low trauma fracture (months 7-36), persistent T-score. ≤ - 2.5 (months 13-36), decrease in bone mineral density (BMD) at any skeletal site. ≥ 5%, or the composite of any one of these outcomes. Results: Of 7435 adherent women, 3110 had either pre- or post-adherent DXA data. In the full cohort, 7% had an incident osteoporotic fracture. In 601 women having both pre- and post-adherent DXA to evaluate BMD change, 6% had fractures, 22% had a post-treatment T-score. ≤ - 2.5, and 16% had BMD decrease by ≥ 5%. The composite outcomes occurred in 35%. Incident fracture was predicted by age, previous fracture, and a variety of co-morbidities, but not by race, glucocorticoid treatment or type of bisphosphonate. Conclusion: Despite bisphosphonate adherence, 7% had incident osteoporotic fractures and 35% had either fracture, decreases in BMD, or persistent osteoporotic BMD, representing a substantial proportion of treated patients in clinical practices remaining at risk for future fractures. Further studies are required to determine the best achievable goals for osteoporosis therapy, and which patients would benefit from alternate therapies.

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