Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy. (14th October 2020)

• Record Type: Journal Article
• Authors: Whitney, Daniel G.
• Is Part Of: Epilepsia. Volume 61:issue 11(2020)
• Page Start: 2583
• Page End: 2592
• Publication Date: 2020-10-14
• Subjects: epilepsy -- fracture -- osteoporosis medication; Epilepsy -- Periodicals; 616.853
• DOI: 10.1111/epi.16700
• Languages: English
• ISSNs: 0013-9580

Abstract

Abstract: Objective: The objective of this propensity score‐matched, observational cohort study was to determine the effectiveness of osteoporosis medication on reducing the risk of non‐trauma fracture (NTFx) among adults with epilepsy. Methods: Data from 01/01/2012 to 09/30/2015 was extracted from Optum Clinformatics Data Mart. NTFx risk attenuation from 12 months prior to 12 months after the individual's index date was examined for each group of adults ≥50 years of age as risk ratios (RRs with 95% confidence intervals [CIs]). Groups were stratified based on: (1) epilepsy status, as with vs without epilepsy (EP); and (2) if and when osteoporosis medication was first prescribed, as new users (treatment naive), consistent users (osteoporosis medication prescribed in pre‐index period), and no users. Comparison groups were matched 1:1 to EP new users (n = 828/group) for demographics, glucocorticoid and antiseizure medication, and the Elixhauser comorbidity index. Difference‐in‐difference analysis compared the change in pre‐ to post‐index NTFx risk among groups as the ratio of the RR (RRR). Results: The pre‐ to post‐index NTFx risk at any site was reduced for EP new users (RR = 0.49; 95% CI = 0.40‐0.61) and EP consistent users (RR = 0.70; 95% CI = 0.38‐0.98), but nonsignificantly elevated for EP no users (RR = 1.39; 95% CI = 0.93‐2.07)—findings were consistent for most sites (eg, vertebral column). EP new users had a larger NTFx risk attenuation at any site compared to EP no users (RRR = 0.35; 95% CI = 0.23‐0.54) and EP consistent users (RRR = 0.70; 95% CI = 0.51‐0.97). EP consistent users had a larger NTFx risk attenuation at any site compared to EP no users (RRR = 0.50; 95% CI = 0.32‐0.79). The extent of NTFx risk attenuation at any site was similar for new users with vs without epilepsy (RRR = 0.99; 95% CI = 0.73‐1.34) and consistent users with vs without epilepsy (RRR = 0.81; 95% CI = 0.55‐1.17). There was evidence of site‐specific effects (eg, hip). Conclusion: Osteoporosis medication is associated with a clinically meaningful 12‐month NTFx risk attenuation for adults with epilepsy, especially for those just starting osteoporosis medication.