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Alendronate use and the risk of nonvertebral fracture during glucocorticoid therapy: a retrospective cohort study
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
2018 (Engelska)Ingår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 103, nr 1, s. 306-313Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
Cary: Oxford University Press, 2018. Vol. 103, nr 1, s. 306-313
Nyckelord [en]
bone-mineral density, induced osteoporosis, postmenopausal women, vertebral fracture, double-blind, metaanalysis, prevention, prevalence, trial, efficacy
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
URN: urn:nbn:se:umu:diva-141851DOI: 10.1210/jc.2017-01912ISI: 000424934300036PubMedID: 29126139OAI: oai:DiVA.org:umu-141851DiVA, id: diva2:1156693
Tillgänglig från: 2017-11-14 Skapad: 2017-11-14 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Bergman, JonathanNordström, AnnaNordström, Peter

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