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Alendronate use and the risk of nonvertebral fracture during glucocorticoid therapy: a retrospective cohort study
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2018 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 103, no 1, p. 306-313Article in journal (Refereed) Published
Abstract [en]

Context: Glucocorticoids increase the risk of nonvertebral fracture, but no clinical trial has shown that nonvertebral fractures can be prevented by co-administration of an anti-osteoporotic drug.

Objective: To estimate the effect of alendronate on the risk of nonvertebral fracture in older adults taking oral glucocorticoids.

Design: Retrospective cohort study using national Swedish registers.

Setting: Hospitalized care and ambulatory specialist care.

Patients: Among adults aged 50 years or older (N=3,347,959), we identified those who initiated oral glucocorticoid therapy from 2006 through 2011 (≥2.5 mg/day of prednisone or equivalent for ≥91 days). The final analysis included 16,890 alendronate users and 16,890 nonusers, who were matched using time-dependent propensity scores.

Main Outcome Measure: Nonvertebral fracture. This was not pre-specified.

Results: Over a median follow-up of 14.5 months, the incidence rate of nonvertebral fracture was 2.0 cases per 100 person-years in alendronate users and 2.4 cases in nonusers. This difference corresponded to a 16% lower rate in users (hazard ratio 0.84, 95% confidence interval 0.75 to 0.94). For hip fractures specifically, the rate was 34% lower in alendronate users relative to nonusers (hazard ratio 0.66, 95% confidence interval 0.55 to 0.78). The association of alendronate use with a lower risk of nonvertebral fracture was strongest in patients who received high doses of glucocorticoid.

Conclusion: Alendronate use was associated with a lower risk of nonvertebral fracture, including hip fracture. Similar, but not statistically significant, associations have been reported in meta-analyses of clinical trials.

Place, publisher, year, edition, pages
Cary: Oxford University Press, 2018. Vol. 103, no 1, p. 306-313
Keyword [en]
bone-mineral density, induced osteoporosis, postmenopausal women, vertebral fracture, double-blind, metaanalysis, prevention, prevalence, trial, efficacy
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-141851DOI: 10.1210/jc.2017-01912ISI: 000424934300036PubMedID: 29126139OAI: oai:DiVA.org:umu-141851DiVA, id: diva2:1156693
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2018-06-09Bibliographically approved

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Bergman, JonathanNordström, AnnaNordström, Peter

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