Laura D Carbone1, Beverly Gonzalez2, Scott Miskevics3, Cara Ray3, Bella Etingen3, Marylou Guihan4, B Catharine Craven5, Varghese George6, Frances M Weaver7. 1. Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia; Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia. Electronic address: lcarbone@augusta.edu. 2. Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr VA Hospital, Hines, Illinois; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Biostatistics, University of Illinois, Chicago, Illinois; Department of Mathematics, Northeastern Illinois University, Chicago, Illinois. 3. Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr VA Hospital, Hines, Illinois. 4. Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr VA Hospital, Hines, Illinois; Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 5. Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada. 6. Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, Georgia. 7. Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr VA Hospital, Hines, Illinois; Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois.
Abstract
OBJECTIVE: To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID). DESIGN: Propensity-matched case-control analyses. SETTING: United States Veterans Affairs (VA) facilities. PARTICIPANTS: A total of 7989 men and 849 women with an SCID included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified (N=8838). Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incident lower extremity fractures. RESULTS: There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.62-1.77) or women (OR, 1.02; 95% CI, 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR, 1.25; 95% CI, 0.73-2.16), were concomitant users of vitamin D and calcium and a bisphosphonate (OR, 1.05; 95% CI, 0.57-1.96), had more than 1 fracture on different dates during the study period (OR, 0.13; 95% CI, 0.02-1.16) and in those who had undergone DXA testing prior to the date of the bisphosphonate prescription and incident fracture (OR, 1.26; 95% CI, 0.69-2.32). CONCLUSIONS: In men with a traumatic SCI and women with a traumatic SCID, bisphosphonate therapies for osteoporosis do not appear to significantly affect fracture risk. Adequately powered randomized controlled trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population. Published by Elsevier Inc.
OBJECTIVE: To investigate the association between prescriptions for bisphosphonates; calcium and vitamin D supplements; and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury (SCI) or disorder (SCID). DESIGN: Propensity-matched case-control analyses. SETTING: United States Veterans Affairs (VA) facilities. PARTICIPANTS: A total of 7989 men and 849 women with an SCID included in VA administrative databases between October 1, 2005 and October 1, 2015 were identified (N=8838). Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incident lower extremity fractures. RESULTS: There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.62-1.77) or women (OR, 1.02; 95% CI, 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR, 1.25; 95% CI, 0.73-2.16), were concomitant users of vitamin D and calcium and a bisphosphonate (OR, 1.05; 95% CI, 0.57-1.96), had more than 1 fracture on different dates during the study period (OR, 0.13; 95% CI, 0.02-1.16) and in those who had undergone DXA testing prior to the date of the bisphosphonate prescription and incident fracture (OR, 1.26; 95% CI, 0.69-2.32). CONCLUSIONS: In men with a traumatic SCI and women with a traumatic SCID, bisphosphonate therapies for osteoporosis do not appear to significantly affect fracture risk. Adequately powered randomized controlled trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population. Published by Elsevier Inc.
Authors: Michelle A Tucci; Yilianys Pride; Suzanne Strickland; Susanna M Salazar Marocho; Ramon J Jackson; Joshua R Jefferson; Alejandro R Chade; Raymond J Grill; Bernadette E Grayson Journal: Neurotrauma Rep Date: 2021-06-22