Long-term persistence with anti-osteoporosis drugs after fracture

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

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Abstract

A 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: 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.

Original languageEnglish
Pages (from-to)1831-1840
Number of pages10
JournalOsteoporosis International
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 2015

Keywords

  • Epidemiology
  • Fracture prevention
  • Osteoporosis
  • Persistence
  • Therapeutics
  • RANDOMIZED CONTROLLED-TRIAL
  • POSTMENOPAUSAL WOMEN
  • MEDICATION ADHERENCE
  • ORAL BISPHOSPHONATES
  • SECONDARY PREVENTION
  • VERTEBRAL FRACTURE
  • RISK
  • THERAPY
  • NONADHERENCE
  • EXPOSURE

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