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Risk factors for fracture among current, persistent users of bisphosphonates.

E S LeBlanc1, A G Rosales, A Balasubramanian

  • 1Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA, erin.s.leblanc@kpchr.org.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Bisphosphonate therapy reduces fracture risk but does not eliminate it. Even compliant users face fracture risks, highlighting the need for additional preventive strategies in osteoporosis management.

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Area of Science:

  • Pharmacology
  • Osteoporosis Research
  • Geriatric Medicine

Background:

  • Bisphosphonate therapy is a cornerstone in reducing fracture risk.
  • However, it does not completely eliminate fracture occurrence.
  • Limited data exists on fracture incidence and risk factors in persistent, community-dwelling bisphosphonate users.

Purpose of the Study:

  • To determine the incidence of fractures among persistent, current bisphosphonate users.
  • To identify risk factors for fractures in this population.
  • To inform strategies for enhanced fracture prevention.

Main Methods:

  • Retrospective cohort study of 14,674 bisphosphonate users.
  • Inclusion of highly compliant users (mean medication possession ratio of 94%).
  • Cox proportional hazards models used to identify risk factors.

Main Results:

  • An overall fracture incidence of 3.7 per 100 users per year was observed.
  • Older age, polypharmacy, low bone mineral density, and prior fracture history were associated with increased risk.
  • Specific comorbidities like dementia, chronic kidney disease, and rheumatoid arthritis increased fracture risk.

Conclusions:

  • Persistent bisphosphonate users remain susceptible to fractures.
  • Current fracture prevention strategies may be insufficient for all patients.
  • Additional measures are necessary to further reduce fracture risk in this cohort.