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Population‐based study of the effectiveness of bone‐specific drugs in reducing the risk of osteoporotic fracture
Author(s) -
Perreault Sylvie,
Dragomir Alice,
Blais Lucie,
Moride Yola,
Rossignol Michel,
SteMarie LouisGeorges,
Fernandès Julio Cesar
Publication year - 2008
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.1551
Subject(s) - medicine , osteoporosis , cohort , odds ratio , nested case control study , cohort study , pharmacoepidemiology , logistic regression , population , pediatrics , environmental health , pharmacology , medical prescription
Aim Evidence supports bone‐specific drugs (BSDs) efficacy in the fracture risk reduction. But treatment rates for osteoporosis among high‐risk patients are far below the recommended guidelines. A major concern about BSDs is the lack of adherence with treatment. Objective To determine if BSDs decrease fracture risk in high‐risk elderly women in real clinical setting. Methods A nested case‐control design was used in a cohort of elderly women from the Quebec health databases. Women enter into the cohort if they are 70 years or older between 1995 and 2003. Nested case‐controls were designed for women with a diagnosis of osteoporosis (OP) and for those with a prior fracture. All cases of fractures occurring during follow‐up were matched with 10 randomly selected controls based on age, time period, bone mass density testing, and having a diagnosis of OP or a prior fracture. Use of BSDs before the index date was categorized as follows: short‐term (≤1 year), intermediate‐term (>1 and ≤ 3 years), and long‐term (>3 years). We used an adjusted conditional logistic regression model to assess BSD effect on fracture. Results Among 3170 women who had a fracture, of these women, 1824 had OP and 1346 had a prior fracture. Only long‐term exposure to BSDs among women with OP reduced the fracture risk by 16% (odds ratio: 0.84; 0.73–0.97). Among women with OP, a high number of medical services or use of anticonvulsants or narcotics increased the fracture risk by 12–73%. Among women with a prior fracture, a high number of medical services or risk of fall or use of benzodiazepines, antidepressants, or narcotics increased the fracture risk by 23–77%. Conclusion The incidence of fractures decreased by 16% among women with OP when more than 80% of BSDs was used for at least 3 years. Among women with a prior fracture, fracture risk reduction was not significant. Exposure to BSDs among women with a prior fracture is troubling, given that only approximately 12% of these individuals were being treated, and only 2% was using BSDs for the long term. Copyright © 2008 John Wiley & Sons, Ltd.