Oral bisphosphonates are associated with increased risk of subtrochanteric and diaphyseal fractures in elderly women: a nested case–control study
نویسندگان
چکیده
OBJECTIVES To evaluate the association between bisphosphonate use and the risk of atypical femoral fractures among women aged 65 or older. DESIGN Nested case-control study. SETTING General practice research database in Spain. EXPOSURES Use of oral bisphosphonates before the occurrence of atypical fractures among cases or the corresponding index date among controls. Bisphosphonate use was categorised as ever versus never users. Ever users were divided according to the total time since first prescription. MAIN OUTCOME MEASURES Cases were defined as women aged 65 years or older with a first diagnosis of subtrochanteric or diaphyseal fracture, recorded in the BIFAP database between 1 January 2005 and 31 December 2008, and with at least 1 year of follow-up before the index date. For each case, five age-matched and calendar-year-matched controls without a history of hip or atypical fracture were randomly selected from the database. STATISTICAL ANALYSIS OR of atypical femoral fracture by bisphosphonate use was determined using conditional logistic regression. Models were adjusted for comorbidities and use of other medications. RESULTS The analysis included 44 cases and 220 matched controls (mean age, 82 years). Ever use of bisphosphonates was more frequent in cases than controls (29.6% vs 10.5%). In multivariate analyses, OR (95% CI) of atypical femoral fracture was 4.30 (1.55 to 11.9) in ever versus never users of bisphosphonates. The risk increased with long-term use, with an OR of 9.46 (2.17 to 41.3) comparing those using bisphosphonates over 3 years versus no users (p for trend=0.01). CONCLUSIONS Bisphosphonate use was associated with an increased risk of subtrochanteric or diaphyseal fractures in elderly women in a low fracture risk population, with a higher risk among long-term bisphosphonate users.
منابع مشابه
Oral Bisphosphonates and Risk of Subtrochanteric or Diaphyseal Femur Fractures in a Population-Based Cohort
Bisphosphonates are the primary therapy for postmenopausal and glucocorticoid-induced osteoporosis. Case series suggest a potential link between prolonged use of bisphosphonates and low-energy fracture of subtrochanteric or diaphyseal femur as a consequence of oversuppression of bone resorption. Using health care utilization data, we conducted a propensity score-matched cohort study to examine ...
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BACKGROUND The problem of atypical fractures, such as subtrochanteric or diaphyseal femoral fractures, associated with long-term treatment with bisphosphonates (BPs) has recently been given increasingly more attention. These fractures develop as stress fractures and are characterised by diaphyseal cortical thickening and a transverse or slightly oblique fracture line. The use of bisphosphonates...
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