Top

Osteoporosis International

Published in:

01-01-2013 | Original Article

Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice

Authors: T. Thomas, S. Horlait, J. D. Ringe, A. Abelson, D. T. Gold, P. Atlan, J. L. Lange

Published in: Osteoporosis International | Issue 1/2013

Abstract

Summary

This study aims to estimate bisphosphonate effectiveness by comparing fracture incidence over time on therapy in glucocorticoid-induced osteoporosis (GIO). From this observational study, alendronate and risedronate decreased clinical vertebral and nonvertebral fractures over time. The effectiveness of each bisphosphonate is consistent with their efficacies demonstrated on surrogate markers in randomized controlled trials (RCTs).

Introduction

This study aims to estimate bisphosphonate effectiveness by comparing fracture incidence over time on therapy with fracture incidence during a short period after starting a therapy.

Methods

The study population was a subgroup of a larger cohort study comprising two cohorts of women aged ≥65 years, prescribed with alendronate or risedronate. Within the two study cohorts, 11,007 women were identified as having received glucocorticoids. Within each cohort, the baseline incidence of clinical fractures at nonvertebral and vertebral sites was defined by the initial 3-month period after starting therapy. Relative to these baseline data, we then compared the fracture incidence during the subsequent 12 months on therapy.

Results

The baseline incidence of clinical nonvertebral and vertebral fractures was similar in the alendronate cohort (5.22 and 5.79/100 person-years, respectively) and in the risedronate cohort (5.51 and 5.68/100 person-years, respectively). Relative to the baseline incidence, fracture incidence was significantly lower in the subsequent 12 months in both cohorts of alendronate (33 % lower at nonvertebral sites and 59 % at vertebral sites) and risedronate (28 % lower at nonvertebral sites and 54 % at vertebral sites).

Conclusion

From this observational study not designed to compare drugs, both alendronate and risedronate decreased clinical vertebral and nonvertebral fractures over time. The reductions observed in fracture incidence, within each cohort, suggest that the effectiveness of each bisphosphonate in clinical practice is consistent with their efficacies demonstrated on surrogate markers in randomized controlled trials.

Walsh LJ, Wong CA, Pringle M, Tattersfield AE (1996) Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 313:344–346PubMedCrossRef

van Staa TP, Leufkens HG, Abenhaim L, Begaud B, Zhang B, Cooper C (2000) Use of oral corticosteroids in the United Kingdom. QJM 93:105–111PubMedCrossRef

Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000PubMedCrossRef

Curtis JR, Westfall AO, Allison JJ, Becker A, Casebeer L, Freeman A, Spettell CM, Weissman NW, Wilke S, Saag KG (2005) Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients. Arthritis Rheum 52:2485–2494PubMedCrossRef

Cohen S, Levy RM, Keller M, Boling E, Emkey RD, Greenwald M, Zizic TM, Wallach S, Sewell KL, Lukert BP, Axelrod DW, Chines AA (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318PubMedCrossRef

Reid DM, Hughes RA, Laan RF, Sacco-Gibson NA, Wenderoth DH, Adami S, Eusebio RA, Devogelaer JP (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study. J Bone Miner Res 15:1006–1013PubMedCrossRef

Silverman SL, Watts NB, Delmas PD, Lange JL, Lindsay R (2007) Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: the risedronate and alendronate (REAL) cohort study. Osteoporos Int 18:25–34PubMedCrossRef

Cadarette SM, Katz JN, Brookhart MA, Stürmer T, Stedman MR, Solomon DH (2008) Relative effectiveness of osteoporosis drugs for preventing non-vertebral fracture. Ann Intern Med 148:637–646PubMed

Curtis JR, Westfall AO, Cheng H, Saag KG, Delzell E (2009) RisedronatE and ALendronate intervention over three years (REALITY): minimal differences in fracture risk reduction. Osteoporos Int 20:973–978PubMedCrossRef

10.

Harris ST, Reginster JY, Harley C, Blumentals WA, Poston SA, Barr CE, Silverman SL (2009) Risk of fracture in women treated with monthly oral ibandronate or weekly bisphosphonates: the eValuation of IBandronate Efficacy (VIBE) database fracture study. Bone 44:758–765PubMedCrossRef

11.

Abelson A, Ringe JD, Gold DT, Lange JL, Thomas T (2010) Longitudinal change in clinical fracture incidence after initiation of bisphosphonates. Osteoporos Int 21:1021–1029PubMedCrossRef

12.

Harrington JT, Ste-Marie LG, Brandi ML, Civitelli R, Fardellone P, Grauer A, Barton I, Boonen S (2004) Risedronate rapidly reduces the risk for nonvertebral fractures in women with postmenopausal osteoporosis. Calcif Tissue Int 74:129–135PubMedCrossRef

13.

Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, Nevitt MC, Suryawanshi S, Cummings SR, Trial FI (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85:4118–4124PubMedCrossRef

14.

Curtis JR, Westfall AO, Cheng H, Lyles K, Saag KG, Delzell E (2008) Benefit of adherence with bisphosphonates depends on age and fracture type: results from an analysis of 101,038 new bisphosphonate users. J Bone Miner Res 23:1435–1441PubMedCrossRef

15.

Melton LJ 3rd, Thamer M, Ray NF, Chan JK, Chesnut CH 3rd, Einhorn TA, Johnston CC, Raisz LG, Silverman SL, Siris ES (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12:16–23PubMedCrossRef

16.

Penning-van Beest FJ, Erkens JA, Olson M, Herings RM (2008) Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int 19:511–517PubMedCrossRef

17.

Gallagher AM, Rietbrock S, Olson M, van Staa TP (2008) Fracture outcomes related to persistence and compliance with oral bisphosphonates. J Bone Miner Res 23:1569–1575PubMedCrossRef

18.

Meijer WM, Penning-van Beest FJ, Olson M, Herings RM (2008) Relationship between duration of compliant bisphosphonate use and the risk of osteoporotic fractures. Curr Med Res Opin 24:3217–3222PubMedCrossRef

19.

Rabenda V, Mertens R, Fabri V, Vanoverloop J, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2008) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int 19:811–818PubMedCrossRef

20.

Sunyecz JA, Mucha L, Baser O, Barr CE, Amonkar MM (2008) Impact of compliance and persistence with bisphosphonate therapy on health care costs and utilization. Osteoporos Int 19:1421–1429PubMedCrossRef

21.

Curtis JR, Westfall AO, Cheng H, Delzell E, Saag KG (2008) Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int 19:1613–1620PubMedCrossRef

22.

Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928PubMedCrossRef

23.

Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022PubMedCrossRef

24.

Adachi JD, Saag KG, Delmas PD, Liberman UA, Emkey RD, Seeman E, Lane NE, Kaufman JM, Poubelle PE, Hawkins F, Correa-Rotter R, Menkes CJ, Rodriguez-Portales JA, Schnitzer TJ, Block JA, Wing J, McIlwain HH, Westhovens R, Brown J, Melo-Gomes JA, Gruber BL, Yanover MJ, Leite MO, Siminoski KG, Nevitt MC, Sharp JT, Malice MP, Dumortier T, Czachur M, Carofano W, Daifotis A (2001) Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum 44:202–211PubMedCrossRef

25.

Wallach S, Cohen S, Reid DM, Hughes RA, Hosking DJ, Laan RF, Doherty SM, Maricic M, Rosen C, Brown J, Barton I, Chines AA (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67:277–285PubMedCrossRef

26.

Compston J, Reid DM, Boisdron J, Brandi ML, Burlet N, Cahall D, Delmas PD, Dere W, Devogelaer JP, Fitzpatrick LA, Flamion B, Goel N, Korte S, Laslop A, Mitlak B, Ormarsdottir S, Ringe J, Rizzoli R, Tsouderos Y, Van Staa T, Reginster JY, Group for the Respect of Ethics and Excellence in Science (2008) Recommendations for the registration of agents for prevention and treatment of glucocorticoid-induced osteoporosis: an update from the Group for the Respect of Ethics and Excellence in Science. Osteoporos Int 19:1247–1250PubMedCrossRef

27.

Steinbuch M, Youket TE, Cohen S (2004) Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 15:323–328PubMedCrossRef

28.

Beukelman T, Saag KG, Curtis JR, Kilgore ML, Pisu M (2010) Cost-effectiveness of multifaceted evidence implementation programs for the prevention of glucocorticoid-induced osteoporosis. Osteoporos Int 21:1573–1584PubMedCrossRef

29.

Dawson-Hughes B, Looker AC, Tosteson AN, Johansson H, Kanis JA, Melton LJ 3rd (2010) The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporos Int 21:41–52PubMedCrossRef

30.

Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45:703–714PubMedCrossRef

Title: Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice
Authors: T. Thomas
S. Horlait
J. D. Ringe
A. Abelson
D. T. Gold
P. Atlan
J. L. Lange
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 1/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-012-2060-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men

Erratum to: Life-course evidence of birth weight effects on bone mass: systematic review and meta-analysis

The impact of dietary calcium intake and vitamin D status on the effects of zoledronate

Vitamin D status is associated with physical performance: the results of three independent cohorts

Analysis of the association between bisphosphonate treatment survival in Danish hip fracture patients—a nationwide register-based open cohort study

Cost-effectiveness of nutritional intervention in elderly subjects after hip fracture. A randomized controlled trial