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Osteoporosis International
Published in: Osteoporosis International 6/2015

Open Access 01-06-2015 | Original Article

Long-term persistence with anti-osteoporosis drugs after fracture

Authors: C. Klop, P. M. J. Welsing, P. J. M. Elders, J. A. Overbeek, P. C. Souverein, A. M. Burden, H. A. W. van Onzenoort, H. G. M. Leufkens, J. W. J. Bijlsma, F. de Vries

Published in: Osteoporosis International | Issue 6/2015

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Abstract

Summary

Long-term persistence with anti-osteoporosis drugs and determinants for discontinuation among fracture patients were examined. Persistence was 75.0 and 45.3 % after 1 and 5 years, respectively. Those aged ≥80 years were at increased risk of early discontinuation. Within 1 year after discontinuation, 24.3 % restarted therapy, yet 47.0 % persisted for 1 year.

Introduction

The risk of osteoporotic fracture can effectively be reduced with use of anti-osteoporosis drugs. However, little is known about persistence with these drugs after fracture where subsequent fracture risk is high. The aims were to determine long-term persistence with anti-osteoporosis drugs among fracture patients, including its determinants, and to describe restart and subsequent persistence.

Methods

A cohort study was conducted within the Dutch PHARMO Database Network. Patients aged ≥50 years (n = 961) who received anti-osteoporosis drugs within 1 year after fracture, but not in the preceding year, were included (2002–2011). Persistence (defined as the proportion on treatment) and the proportion restarting after discontinuation were estimated using Kaplan-Meier analyses. Time-dependent Cox regression was used to identify determinants of non-persistence including age, sex, initial dosage regime, fracture type, comorbidities, and drug use.

Results

Persistence with anti-osteoporosis drugs was 75.0 % (95 % confidence interval (CI) 72.0–77.7) and 45.3 % (95 % CI 40.4–50.0) after 1 and 5 years, respectively. A significant determinant of non-persistence was age ≥80 years (reference 50–59 years: adjusted hazard ratio [adj. HR] 1.65; 95 % CI 1.15–2.38). This effect was not constant over time (≤360 days following initiation: adj. HR 2.07; 95 % CI 1.27–3.37; >360 days: adj. HR 1.08; 95 % CI 0.62–1.88). Within 1 year after discontinuation, 24.3 % (95 % CI 20.1–29.2) restarted therapy, yet 47.0 % persisted for 1 year.

Conclusions

This study identified suboptimal persistence with anti-osteoporosis drugs among fracture patients. Major target groups for measures aimed to improve persistence may be those aged >80 years and those restarting therapy.
Appendix
Available only for authorised users
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Metadata
Title
Long-term persistence with anti-osteoporosis drugs after fracture
Authors
C. Klop
P. M. J. Welsing
P. J. M. Elders
J. A. Overbeek
P. C. Souverein
A. M. Burden
H. A. W. van Onzenoort
H. G. M. Leufkens
J. W. J. Bijlsma
F. de Vries
Publication date
01-06-2015
Publisher
Springer London
Published in
Osteoporosis International / Issue 6/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-015-3084-3

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