Determinants of Oral Bisphosphonate Use Beyond 5 Years

Area of Science:

• Osteoporosis management
• Pharmacotherapy adherence
• Bone health research

Background:

• Limited research exists on factors influencing bisphosphonate (BP) continuation past 5 years in clinical settings.
• Understanding these factors is crucial for optimizing long-term osteoporosis treatment.

Purpose of the Study:

• To identify clinical and demographic factors associated with bisphosphonate (BP) continuation in women who completed 5 years of therapy.
• To inform clinical decision-making for extended osteoporosis treatment.

Main Methods:

• A cohort of 19,091 women receiving 5 years of oral BP treatment was analyzed.
• Multivariable logistic regression evaluated associations between baseline/time-varying factors and treatment continuation for up to 5 additional years.

Main Results:

• Lower bone mineral density (BMD) T-scores (≤ -2.0), earlier treatment initiation (pre-2008), and diabetes mellitus were associated with increased BP continuation.
• Recent fractures, higher comorbidity scores (Charlson > 2), rheumatoid arthritis, and proton pump inhibitor (PPI) use were associated with decreased continuation.

Conclusions:

• Low BMD T-scores, absence of recent fractures, and earlier treatment eras predict continued bisphosphonate (BP) use beyond 5 years.
• Proton pump inhibitor (PPI) use was linked to lower BP continuation rates, suggesting potential interactions or patient-specific factors.