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J Clin Endocrinol Metab. 2013 Dec;98(12):4717-26. doi: 10.1210/jc.2013-1877. Epub 2013 Sep 30.

Comparative effectiveness of osteoporosis drugs in preventing secondary nonvertebral fractures in Taiwanese women.

Author information

  • 1BS Pharm, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, University Road, Tainan, 70101, Taiwan. yhkao@mail.ncku.edu.tw.

Abstract

CONTEXT:

The evidence for relative effectiveness of osteoporosis drugs in secondary prevention of nonvertebral fractures was unclear and could not be extrapolated to the Asian population.

OBJECTIVE:

The objective of the study was to compare the relative effectiveness of different classes of osteoporosis drugs in secondary prevention of nonvertebral fractures in Taiwanese women.

DESIGN:

This was a retrospective cohort study from 2003 to 2007, with up to 6 years of follow-up. Setting: The study included enrollees in Taiwan National Health Insurance.

PATIENTS:

Patients older than 50 years, with vertebral/hip fracture and were new to osteoporosis therapy, were recruited.

INTERVENTION:

Patients were classified into the alendronate, calcitonin, or raloxifene group, according to their exposure after follow-up.

MAIN OUTCOME MEASURE:

The primary outcome of our study was the risk of incident nonvertebral fracture (hip, humerus, or radius fractures). A multivariate Cox proportional hazard model adjusted for fracture risk factors was used to compare the relative fracture risk among three treatment groups under on-treatment scenarios. Propensity score-matched hazard ratios were examined, and interactions between fracture incidence and patients' compliance were investigated as well.

RESULTS:

There were 19 840, 9534, and 25 483 patients in the alendronate, raloxifene, and calcitonin groups, respectively. The fracture rates were highest in calcitonin recipients (4.57 per 100 person-years), followed by raloxifene and alendronate. Results from Cox analyses showed raloxifene (hazard ratio 1.47; 95% confidence interval 1.29-1.67) and calcitonin (hazard ratio 1.51; 95% confidence interval 1.29-1.75) had higher nonvertebral fracture risks as compared with alendronate. The risk differences were more pronounced in compliant patients.

CONCLUSION:

We found alendronate users had the lowest secondary nonvertebral fracture risk, as compared with raloxifene and calcitonin users. Consistent results were found in a series of sensitivity analyses.

PMID:
24081731
[PubMed - indexed for MEDLINE]
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