Huifeng Yun1, Elizabeth Delzell2, Kenneth G Saag1, Meredith L Kilgore3, Michael A Morrisey3, Paul Muntner2, Robert Matthews2, Lingli Guo2, Nicole Wright2, Wilson Smith2, Cathleen Colón-Emeric4, Christopher M O'Connor5, Kenneth W Lyles6, Jeffrey R Curtis1. 1. Department of Epidemiology, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA. 2. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. 3. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Duke University Medical Center and the Durham VA GRECC, Durham, NC, USA. 5. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. 6. Duke University Medical Center and the Durham VA GRECC, Durham; and The Carolinas Center for Medical Excellence, Cary NC, USA.
Abstract
OBJECTIVES: Few studies have assessed the effectiveness of different drugs for osteoporosis (OP). We aimed to determine if fracture and mortality rates vary among patients initiating different OP medications. METHODS: We used the Medicare 5% sample to identify new users of intravenous (IV) zoledronic acid (n=1.674), oral bisphosphonates (n=32.626), IV ibandronate (n=492), calcitonin (n=2.606), raloxifene (n=1.950), or parathyroid hormone (n=549). We included beneficiaries who were ≥65 years of age, were continuously enrolled in fee-for-service Medicare and initiated therapy during 2007-2009. Outcomes were hip fracture, clinical vertebral fracture, and all-cause mortality, identified using inpatient and physician diagnosis codes for fracture, procedure codes for fracture repair, and vital status information. Cox regression models compared users of each medication to users of IV zoledronic acid, adjusting for multiple confounders. RESULTS: During follow-up (median, 0.8-1.5 years depending on the drug), 787 subjects had hip fractures, 986 had clinical vertebral fractures, and 2.999 died. Positive associations included IV ibandronate with hip fracture (adjusted hazard ratio (HR), 2.37; 95% confidence interval (CI) 1.25-4.51), calcitonin with vertebral fracture (HR=1.59, 95%CI 1.04-2.43), and calcitonin with mortality (HR=1.31; 95%CI 1.02-1.68). Adjusted HRs for other drug-outcome comparisons were not statistically significant. CONCLUSIONS: IV ibandronate and calcitonin were associated with higher rates of some types of fracture when compared to IV zolendronic acid. The relatively high mortality associated with use of calcitonin may reflect the poorer health of users of this agent.
OBJECTIVES: Few studies have assessed the effectiveness of different drugs for osteoporosis (OP). We aimed to determine if fracture and mortality rates vary among patients initiating different OP medications. METHODS: We used the Medicare 5% sample to identify new users of intravenous (IV) zoledronic acid (n=1.674), oral bisphosphonates (n=32.626), IV ibandronate (n=492), calcitonin (n=2.606), raloxifene (n=1.950), or parathyroid hormone (n=549). We included beneficiaries who were ≥65 years of age, were continuously enrolled in fee-for-service Medicare and initiated therapy during 2007-2009. Outcomes were hip fracture, clinical vertebral fracture, and all-cause mortality, identified using inpatient and physician diagnosis codes for fracture, procedure codes for fracture repair, and vital status information. Cox regression models compared users of each medication to users of IV zoledronic acid, adjusting for multiple confounders. RESULTS: During follow-up (median, 0.8-1.5 years depending on the drug), 787 subjects had hip fractures, 986 had clinical vertebral fractures, and 2.999 died. Positive associations included IV ibandronate with hip fracture (adjusted hazard ratio (HR), 2.37; 95% confidence interval (CI) 1.25-4.51), calcitonin with vertebral fracture (HR=1.59, 95%CI 1.04-2.43), and calcitonin with mortality (HR=1.31; 95%CI 1.02-1.68). Adjusted HRs for other drug-outcome comparisons were not statistically significant. CONCLUSIONS: IV ibandronate and calcitonin were associated with higher rates of some types of fracture when compared to IV zolendronic acid. The relatively high mortality associated with use of calcitonin may reflect the poorer health of users of this agent.
Authors: Robert B Hopkins; Ron Goeree; Eleanor Pullenayegum; Jonathan D Adachi; Alexandra Papaioannou; Feng Xie; Lehana Thabane Journal: BMC Musculoskelet Disord Date: 2011-09-26 Impact factor: 2.362
Authors: Anna N A Tosteson; Margaret R Grove; Cristina S Hammond; Megan M Moncur; G Thomas Ray; Gwen M Hebert; Alice R Pressman; Bruce Ettinger Journal: Am J Med Date: 2003-08-15 Impact factor: 4.965
Authors: Jeffrey R Curtis; Amy S Mudano; Daniel H Solomon; Juan Xi; Mary Elkins Melton; Kenneth G Saag Journal: Med Care Date: 2009-01 Impact factor: 2.983
Authors: Catherine MacLean; Sydne Newberry; Margaret Maglione; Maureen McMahon; Veena Ranganath; Marika Suttorp; Walter Mojica; Martha Timmer; Alicia Alexander; Melissa McNamara; Sheetal B Desai; Annie Zhou; Susan Chen; Jason Carter; Carlo Tringale; Di Valentine; Breanne Johnsen; Jennifer Grossman Journal: Ann Intern Med Date: 2007-12-17 Impact factor: 25.391
Authors: Katherine E Mues; Alexander Liede; Jiannong Liu; James B Wetmore; Rebecca Zaha; Brian D Bradbury; Allan J Collins; David T Gilbertson Journal: Clin Epidemiol Date: 2017-05-09 Impact factor: 4.790
Authors: Akeem A Yusuf; Steven R Cummings; Nelson B Watts; Maurille Tepie Feudjo; J Michael Sprafka; Jincheng Zhou; Haifeng Guo; Akhila Balasubramanian; Cyrus Cooper Journal: Arch Osteoporos Date: 2018-03-21 Impact factor: 2.617
Authors: N Konstantelos; A M Rzepka; A M Burden; A M Cheung; S Kim; P Grootendorst; S M Cadarette Journal: Osteoporos Int Date: 2022-05-17 Impact factor: 5.071