Bisphosphonate drug holiday: choosing appropriate candidates.
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ABSTRACT:
SUBMITTER: Ro C
PROVIDER: S-EPMC3587311 | biostudies-other | 2013 Mar
REPOSITORIES: biostudies-other
Publications
Bisphosphonate drug holiday: choosing appropriate candidates.
Current osteoporosis reports 20130301 1
Osteoporosis related fractures contribute to morbidity and mortality in U.S. patients, placing a heavy financial burden on society. Randomized clinical trials involving over 30,000 subjects have established bisphosphonates' efficacy in reducing the incidence of fragility fractures. However, as bisphosphonates are retained for years in the skeleton, reports of adverse events from prolonged use are surfacing in the literature, namely, esophageal cancer, atrial fibrillation, osteonecrosis of the ja ...[more]
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Project description:BackgroundDiscontinuation of bisphosphonates (BP) or a "drug holiday" after several years of treatment is increasingly common. However, the association of drug holiday duration with future fracture risk is unclear.ObjectivesWe evaluated the rate of fracture in relation to various lengths of drug holidays among women receiving long-term BP therapy.Research designObservational cohort study using US Medicare data 2006-2016. Incidence rates (IRs) and Cox proportional hazards models were used to evaluate the rate and adjusted hazard ratios (aHRs) controlling for potential confounders.SubjectsWomen aged 65 years and above enrolled in fee-for-service Medicare who had been adherent (≥80%) to alendronate, risedronate, or zoledronate for ≥3 years.MeasuresHip, humerus, distal forearm, and clinical vertebral fracture.ResultsAmong 81,427 eligible women observed for a median (interquartile range) of 4.0 (2.5, 5.3) years, 28% of women underwent a drug holiday. In the alendronate cohort (73% overall), the IR of hip fracture among women who discontinued BP for >2 years was 13.2 per 1000 person-years. Risk was increased (aHR=1.3, 1.1-1.4) versus continuing therapy (IR=8.8, referent). Rates were elevated for humerus fracture with discontinuation >2 years (aHR=1.3, 1.1-1.66) and for clinical vertebral fracture with discontinuation >2 years (aHR=1.2, 1.1-1.4). Results were similar for risedronate, zoledronate, and ibandronate for hip and clinical vertebral fracture.ConclusionDiscontinuing alendronate beyond 2 years was associated with increased risk of hip, humerus, and clinical vertebral fractures.
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