Kevin W McConeghy1, Andrew R Zullo2, Christine W Lary3, Tingting Zhang2, Yoojin Lee2, Lori Daiello4, Douglas P Kiel5, Sarah Berry5. 1. Center of Innovation Long-term Services and Support, Providence Veterans Affairs Medical Center, Providence, RI; School of Public Health Brown University, Providence, RI; University of Rhode Island, College of Pharmacy, Kingston, RI. Electronic address: Kevin.mcconeghy@va.gov. 2. Center of Innovation Long-term Services and Support, Providence Veterans Affairs Medical Center, Providence, RI; School of Public Health Brown University, Providence, RI. 3. Maine Medical Center for Outcomes Research & Evaluation, Portland, ME. 4. School of Public Health Brown University, Providence, RI. 5. Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, MA; Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA.
Abstract
OBJECTIVES: Clostridioides difficile infection is a major source of morbidity and mortality among frail older adults, especially those in nursing homes (NHs). Safety reports have signaled that bisphosphonate use may be a contributing cause. We therefore evaluated the risk of C difficile hospitalization associated with oral bisphosphonate use in the NH. DESIGN: Observational, retrospective new-user cohort study. SETTING: The cohort included US NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH) between January 1, 2008 and December 31, 2009. METHODS: We conducted a study of NH residents using linked Medicare claims and Minimum Data Set records. Residents were new users of an oral bisphosphonate 1:1 matched to new calcitonin users ("active" comparator) on propensity scores controlling for more than 100 covariates. The outcome was risk of hospitalization for C difficile infection in a Cox proportional hazards model adjusted for previous antibiotic and proton pump inhibitor use. RESULTS: Our final analytical cohort included 17,753 bisphosphonate and 5348 calcitonin users. In the matched cohort, 84/5209 (1.6%) vs 71/5209 (1.4%) C difficile-related hospitalizations occurred in bisphosphonate and calcitonin users, respectively. We observed no significant difference in the risk of hospitalization among bisphosphonate users (hazard ratio: 1.11, 95% confidence interval: 0.80-1.51). Antibiotic and proton pump inhibitor exposure before and after osteoporosis treatment was also similar between bisphosphonate and calcitonin users. CONCLUSIONS AND IMPLICATIONS: C difficile infection should not be a consideration when prescribing bisphosphonates to frail older adults given the lack of a significant association.
OBJECTIVES: Clostridioides difficile infection is a major source of morbidity and mortality among frail older adults, especially those in nursing homes (NHs). Safety reports have signaled that bisphosphonate use may be a contributing cause. We therefore evaluated the risk of C difficile hospitalization associated with oral bisphosphonate use in the NH. DESIGN: Observational, retrospective new-user cohort study. SETTING: The cohort included US NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH) between January 1, 2008 and December 31, 2009. METHODS: We conducted a study of NH residents using linked Medicare claims and Minimum Data Set records. Residents were new users of an oral bisphosphonate 1:1 matched to new calcitonin users ("active" comparator) on propensity scores controlling for more than 100 covariates. The outcome was risk of hospitalization for C difficile infection in a Cox proportional hazards model adjusted for previous antibiotic and proton pump inhibitor use. RESULTS: Our final analytical cohort included 17,753 bisphosphonate and 5348 calcitonin users. In the matched cohort, 84/5209 (1.6%) vs 71/5209 (1.4%) C difficile-related hospitalizations occurred in bisphosphonate and calcitonin users, respectively. We observed no significant difference in the risk of hospitalization among bisphosphonate users (hazard ratio: 1.11, 95% confidence interval: 0.80-1.51). Antibiotic and proton pump inhibitor exposure before and after osteoporosis treatment was also similar between bisphosphonate and calcitonin users. CONCLUSIONS AND IMPLICATIONS: C difficile infection should not be a consideration when prescribing bisphosphonates to frail older adults given the lack of a significant association.
Authors: Sarah D Berry; Andrew R Zullo; Yoojin Lee; Vincent Mor; Kevin W McConeghy; Geetanjoli Banerjee; Ralph B D'Agostino; Lori Daiello; David Dosa; Douglas P Kiel Journal: J Gerontol A Biol Sci Med Sci Date: 2018-05-09 Impact factor: 6.053
Authors: Adriana M A Menezes; Francisco Airton C Rocha; Hellíada V Chaves; Cibele B M Carvalho; Ronaldo A Ribeiro; Gerly Anne C Brito Journal: J Periodontol Date: 2005-11 Impact factor: 6.993
Authors: Panayiotis D Ziakas; Nina Joyce; Ioannis M Zacharioudakis; Fainareti N Zervou; Richard W Besdine; Vincent Mor; Eleftherios Mylonakis Journal: Medicine (Baltimore) Date: 2016-08 Impact factor: 1.889