TY - JOUR
T1 - Trajectories of oral bisphosphonate use after hip fractures
T2 - a population-based cohort study
AU - Leung, Miriam T.Y.
AU - Turner, Justin P.
AU - Marquina, Clara
AU - Ilomaki, Jenni
AU - Tran, Tim
AU - Simon Bell, J.
N1 - Funding Information:
MTYL, JPT, CM, and TT have nothing to declare. JI has received grant or consulting funds from the National Health and Medical Research Council, Medical Research Future Fund, Dementia Australia Research Foundation, Yulgilbar Foundation, National Breast Cancer Foundation, AstraZeneca, and Amgen unrelated to this work. JSB has received grant funding or consulting funds from the National Health and Medical Research Council, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations unrelated to this work. All grants and consulting funds were paid to the employing institution.
Funding Information:
Open Access funding enabled and organized by CAUL and its Member Institutions This study was financially supported by the Dementia Australia Research Foundation – Yulgilbar Innovation Grant. MTYL is supported by Australian Government Research Training Scholarship. JSB is supported by a National Health and Medical Research Council (NHMRC) Dementia Leadership Fellowship.
Publisher Copyright:
© 2023, The Author(s).
PY - 2024/1/10
Y1 - 2024/1/10
N2 - Summary: Bisphosphonates prevent future hip fractures. However, we found that one in six patients with hip fractures had a delay in bisphosphonate initiation and another one-sixth discontinued treatment within 12 months after discharge. Our results highlight the need to address hesitancy in treatment initiation and continuous monitoring. Purpose: Suboptimal antiresorptive use is not well understood. This study investigated trajectories of oral bisphosphonate use following first hip fractures and factors associated with different adherence and persistence trajectories. Methods: We conducted a retrospective study of all patients aged ≥ 50 years dispensed two or more bisphosphonate prescriptions following first hip fracture in Victoria, Australia, from 2012 to 2017. Twelve-month trajectories of bisphosphonate use were categorized using group-based trajectory modeling. Factors associated with different trajectories compared to the persistent adherence trajectory were assessed using multivariate multinomial logistic regression. Results: We identified four patterns of oral bisphosphonate use in 1811 patients: persistent adherence (66%); delayed dispensing (17%); early discontinuation (9%); and late discontinuation (9%). Pre-admission bisphosphonate use was associated with a lower risk of delayed dispensing in both sexes (relative risk [RR] 0.28, 95% confidence interval [CI] 0.21–0.39). Older patients (≥ 85 years old versus 50–64 years old, RR 0.38, 95% CI 0.22–0.64) had a lower risk of delayed dispensing. Males with anxiety (RR 9.80, 95% CI 2.24–42.9) and females with previous falls had increased risk of early discontinuation (RR 1.80, 95% CI 1.16–2.78). Conclusion: Two-thirds of patients demonstrated good adherence to oral bisphosphonates over 12 months following hip fracture. Efforts to further increase post-discharge antiresorptive use should be sex-specific and address possible persistent uncertainty around delaying treatment initiation.
AB - Summary: Bisphosphonates prevent future hip fractures. However, we found that one in six patients with hip fractures had a delay in bisphosphonate initiation and another one-sixth discontinued treatment within 12 months after discharge. Our results highlight the need to address hesitancy in treatment initiation and continuous monitoring. Purpose: Suboptimal antiresorptive use is not well understood. This study investigated trajectories of oral bisphosphonate use following first hip fractures and factors associated with different adherence and persistence trajectories. Methods: We conducted a retrospective study of all patients aged ≥ 50 years dispensed two or more bisphosphonate prescriptions following first hip fracture in Victoria, Australia, from 2012 to 2017. Twelve-month trajectories of bisphosphonate use were categorized using group-based trajectory modeling. Factors associated with different trajectories compared to the persistent adherence trajectory were assessed using multivariate multinomial logistic regression. Results: We identified four patterns of oral bisphosphonate use in 1811 patients: persistent adherence (66%); delayed dispensing (17%); early discontinuation (9%); and late discontinuation (9%). Pre-admission bisphosphonate use was associated with a lower risk of delayed dispensing in both sexes (relative risk [RR] 0.28, 95% confidence interval [CI] 0.21–0.39). Older patients (≥ 85 years old versus 50–64 years old, RR 0.38, 95% CI 0.22–0.64) had a lower risk of delayed dispensing. Males with anxiety (RR 9.80, 95% CI 2.24–42.9) and females with previous falls had increased risk of early discontinuation (RR 1.80, 95% CI 1.16–2.78). Conclusion: Two-thirds of patients demonstrated good adherence to oral bisphosphonates over 12 months following hip fracture. Efforts to further increase post-discharge antiresorptive use should be sex-specific and address possible persistent uncertainty around delaying treatment initiation.
KW - Antiresorptive medication
KW - Bisphosphonate
KW - Hip fracture
KW - Osteoporosis
UR - http://www.scopus.com/inward/record.url?scp=85181958337&partnerID=8YFLogxK
U2 - 10.1007/s00198-023-06974-6
DO - 10.1007/s00198-023-06974-6
M3 - Article
AN - SCOPUS:85181958337
SN - 0937-941X
VL - 35
SP - 669
EP - 678
JO - Osteoporosis International
JF - Osteoporosis International
IS - 4
ER -
