NEW YORK (Reuters Health)—Early oral bisphosphonate use is associated with a lower risk of fractures among oral-glucocorticoid users, researchers from Canada report.
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Bisphosphonates are commonly used for glucocorticoid-induced osteoporosis, but their efficacy has been established only in primary osteoporosis, where the mechanism of action of bone loss differs from that seen with glucocorticoid use.
Dr. M. Amine Amiche from the University of Toronto and colleagues used administrative healthcare data from Ontario to estimate the effectiveness of alendronate, etidronate and risedronate in reducing fracture risk among more than 140,000 adults age 66 or older who initiated chronic oral glucocorticoid therapy.
Compared with no bisphosphonate treatment, alendronate was associated with a reduction of one-year hip-fracture risk of 54% (from 9.9 to 5.2 events per 1,000 person-years) and a reduction in vertebral-fracture risk of 48%, the team reports in the Journal of Bone and Mineral Research, online October 25.
Risedronate was linked to a 42% lower hip-fracture risk and a 53% lower vertebral-fracture risk, while etidronate was linked to a 41% lower vertebral-fracture risk but had no significant association with hip-fracture risk.
None of the bisphosphonates was associated with fracture risk in the forearm or humerus.
Results were consistent when stratified by sex and for longer follow-up periods.
“Our study adds to the growing body of literature demonstrating the effectiveness of oral bisphosphonates in reducing fracture risk in glucocorticoid-induced osteoporosis,” the researchers conclude.
“We hope that our results will help to improve the management of glucocorticoid-induced osteoporosis by providing real-world evidence of the benefit of alendronate and risedronate in preventing glucocorticoid-associated fractures,” they add. “Future studies should examine the comparative effectiveness of oral bisphosphonates among oral glucocorticoid users, as well as their effectiveness compared to newer agents with less frequent dosing interval, like zoledronic acid and denosumab.”
Dr. Amiche did not respond to a request for comments.
The study did not have commercial funding. One of the five authors reported having participated in clinical trials for the prevention and treatment of glucocorticoid-induced osteoporosis and having received consulting fees and research grants from various pharmaceutical companies.
- Amiche MA, Lévesque LE, Gomes T, et al. Effectiveness of oral bisphosphonates in reducing fracture risk among oral glucocorticoid users: three matched cohort analyses. Journal of Bone Mineral Research. 2017 Oct 25. [Epub ahead of print]