Does Extending Bisphosphate Therapy Beyond 5 Years Lead to Lower Risk of Hip Fracture?
BACKGROUND AND PURPOSE:
Bisphosphate drugs have a known ability to reduce fractures during the first 3 to 5 years of therapy; however, the optimal duration of treatment is unknown
Izano et al. (JAMA Network Open, 2020) examined whether continuing this medication for 5 additional years impacts the risk of hip fracture among women
Retrospective cohort study
Data from Kaiser Permanente Northern and Southern California
Women were between 45 to 80 years at bisphosphonate initiation | At least 60% adherent to therapy in each of the 5 years after initiation
Completed 5 years of treatment by study entry (Jan 1, 2002 to Sep 30, 2014)
Bisphosphonates: Alendronate, risedronate, or ibandronate
Patients were grouped into 3 discontinuation timeframes (following completion of the initial 5 years)
2 additional years
5 additional years
Mean (IQR) age: 71 (64 to 77) years
60% non-Hispanic white
Hip fractures: 507 incidents
Compared with discontinuation at study entry, there were no differences in the risk of hip fracture if women remained on therapy for
2 additional years
5-year risk difference (RD) −2.2 per 1000 individuals (95% CI, −20.3 to 15.9)
5 additional years
5-year RD 3.8 per 1000 individuals (95% CI, −7.4 to 15.0)
There were no significant differences in hip fracture risk between 5 additional years and 2 additional years of treatment
5-year RD 6.0 per 1000 individuals (95% CI, −9.9 to 22.0)
Interim hip fracture risk appeared lower if women discontinued after 2 additional years, but not without a 6-month grace period (additional 6 months before calling the case discontinued)
3-year RD 2.8 per 1000 individuals (95% CI, 1.3 to 4.3)
4-year RD 9.3 per 1000 individuals (95% CI, 6.3 to 12.3)
For women that had already completed 5 years of bisphosphate therapy, there was no difference in hip fracture risk if they discontinued therapy at 5 years, 7 years, or 10 years (total)
The authors conclude that
Our findings of hip fracture risk are similar to the FLEX randomized clinical trial, in which overall clinical fracture risk was not significantly different between those who took placebo or alendronate for an additional 5 years
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