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Arch Osteoporos. 2018 Oct 19;13(1):113. doi: 10.1007/s11657-018-0530-9.

Impact of bisphosphonate compliance on the risk of osteoporotic fracture in France.

Author information

1
HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France. manon.belhassen@univ-lyon1.fr.
2
PharmacoEpidemiology Lyon (PELyon), Lyon, France. manon.belhassen@univ-lyon1.fr.
3
Department of Rheumatology, Lille University Hospital, 2 Avenue Oscar Lambret, 59000, Lille, France.
4
INSERM UMR 1033, Rheumatology Department, University of Lyon, Hospices Civils de Lyon, 69002, Lyon, France.
5
Merck Sharp & Dohme, 3 Avenue Hoche, 75008, Paris, France.
6
PharmacoEpidemiology Lyon (PELyon), Lyon, France.
7
HESPER 7425, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France.

Abstract

Limited information is available on the impact of bisphosphonate compliance levels on fracture risk in osteoporosis patients in France. The results of this nested case-control, retrospective study suggest that fracture risk did not significantly change with bisphosphonate compliance levels, except for highly compliant patients.

PURPOSE/INTRODUCTION:

This was the first study conducted in France to evaluate the impact of compliance levels for bisphosphonates, the most frequently prescribed first-line anti-osteoporotic treatment, on fracture risk.

METHODS:

This retrospective nested case-control study included patients ≥ 50 years old, who were recorded in a random sample of French claims data, did not die between 2006 and 2013, and received ≥ 1 reimbursement for anti-osteoporotic treatment between 2007 and 2013. Cases (patients hospitalised for osteoporosis-related fractures) were matched to 1-3 controls (patients hospitalised for other reasons). Patients hospitalised for fractures within 12 months preceding the first delivery of anti-osteoporotic treatment or during the first 24 months of follow-up were excluded. Bisphosphonate compliance during the 24 months preceding hospitalisation was calculated by the Continuous measure of Medication Acquisition version 7 (CMA7). We evaluated the impact of bisphosphonate compliance (CMA7 ≥ 80%) and very good compliance levels (CMA7 > 90%) on fracture risk.

RESULTS:

In the main analysis, the mean CMA7 values during the 24 months preceding hospitalisation were 48.4% for the 434 cases and 51.3% for the 1123 age-matched controls. An adjusted conditional logistic regression showed no significant impact (odds ratio: 0.851 [95% confidence interval: 0.668, 1.084]) of bisphosphonate compliance on fracture occurrence. In the sensitivity analysis, including one randomly selected control per case and only controls with CMA7 values > 90%, occurrence of fractures was lower (odds ratio: 0.741 [95% confidence interval: 0.608, 0.903]) among the 119 controls.

CONCLUSION:

In conclusion, this study suggested that very high levels of compliance with bisphosphonates are necessary to induce significant decreases in fracture risk.

KEYWORDS:

Epidemiology; Osteoporosis; Outcomes research; Treatment

PMID:
30341636
DOI:
10.1007/s11657-018-0530-9

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