A national study on long-term osteoporosis therapy and risk of recurrent fractures in patients with hip fracture. (May 2020)

• Record Type: Journal Article
• Authors: Hsu, Chiao-Lin; Chen, Hsiu-Min; Chen, Hong-Jhe; Chou, Ming-Yueh; Wang, Yu-Chun; Hsu, Ying-Hsin; Liang, Chih-Kuang; Chu, Che-Sheng
• Is Part Of: Archives of gerontology and geriatrics. Volume 88(2020)
• Publication Date: 2020-05
• Subjects: aHR adjusted hazard ratio -- BMD bone mineral density -- CI confidence interval -- DXA dual-energy X-ray absorptiometry -- HF hip fracture -- ICD-9-CM international classification of diseases, ninth revision, clinical modification -- CCI charlson comorbidity index -- MPR medication possession ratio -- NHI national health insurance -- NHIRD national health insurance research database -- OP osteoporosis -- SD standard deviation; Hip fracture -- Osteoporosis medication persistence -- Recurrent fractures; Aging -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Periodicals; Electronic journals; 305.26
• DOI: 10.1016/j.archger.2020.104021
• Languages: English
• ISSNs: 0167-4943

Abstract

Highlights: The impact of osteoporosis medication persistence on mortality is unclear. OP medication persistence was associated with lower risk of recurrent fracture in patients with hip fracture patients. Patients who were male, were aged ≥ 80 years, and had a higher CCI score had a higher risk of all-cause mortality. Persistent bisphosphonate use was associated with lower recurrent fractures rate but not with lower risk of mortality. Abstract: Objective: The study aimed to evaluate the impact of osteoporosis (OP) medication persistence on subsequent fractures and all-cause mortality in patients with hip fracture. Methods: In this retrospective cohort study, we included patients aged ≥ 40 years with fragility hip fracture from the Taiwan's National Health Insurance Research Database. OP medication persistence was categorized as yes (≥ 12 months) or no (< 12 months). A multivariate Cox proportional hazard model was used to evaluate the association between OP medication persistence and recurrent fractures (including hip, vertebral, and upper and lower limb fractures) and all-cause mortality. Results: A total of 946 patients were included in the study (86.5 % of them aged ≥ 65 years) and 210 patients persistently received OP medications. Persistent OP medication use was associated with lower fracture risk (adjusted hazard ratio [aHR] = 0.64; 95 % CI = 0.41–0.99; P = .043) in the follow-up period. The strongest predictors for all-cause mortality were age ≥ 80 years (HR = 5.68, 95 % CI = 1.36–23.64, P = .017), male sex (HR = 1.55; 95 % CI = 1.18–2.03; P = .002), and Charlson Comorbidity Index ≥ 3 (aHR = 1.56; 95 % CI = 1.07–2.27; P = .022). Kaplan-Meier curves showed a lower cumulative incidence of recurrent fractures in the persistent group than that in the non-persistent group (P = .028). Conclusion: Persistent OP medication use was associated with a lower risk of recurrent fractures but not with mortality in patients with hip fracture.