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- Title
Over half of seniors who start oral bisphosphonate therapy are exposed for 3 or more years: novel rolling window approach and patterns of use.
- Authors
Hayes, K.N.; He, N.; Brown, K.A.; Cheung, A.M.; Juurlink, D.N.; Cadarette, S.M.
- Abstract
Summary: Most adherence studies only consider treatment following a first prescription. Using an extended follow-up, we found that 60% of seniors starting oral bisphosphonate therapy were exposed for ≥ 3 years (48% for ≥ 5 years). Studies are needed to examine the benefits and harms of continuing bisphosphonate therapy beyond 3 years. Introduction: The purpose of this study was to identify and describe patterns of long-term oral bisphosphonate use among seniors using a novel methodological approach that considers extended follow-up. Methods: Among Ontarians aged 66 years or older, we identified subjects with a first dispensing of alendronate or risedronate between November 2000 and December 2016. We followed them until death or December 2019 to identify patients with ≥ 3 years of bisphosphonate use, defined as a proportion of days covered ≥ 80%, using 3-year rolling windows. We calculated the proportion of patients with long-term therapy (≥ 3 years of use) using Kaplan-Meier estimates. We described patterns of long-term use and compared patient characteristics between patients with and without long-term therapy. Results: We identified 260,784 eligible seniors initiating bisphosphonate therapy. Of these, 60% continued therapy ≥ 3 years (77% women), and 48% continued ≥ 5 years. Characteristics did not meaningfully differ between patients with or without long-term therapy. The median length of long-term therapy was 7.0 (IQR 5.1) years for women and 6.1 (IQR 4.3) years for men. Only 20% experienced a treatment gap before long-term therapy, yet 50% experienced a treatment gap of ≥ 120 days after a median 5.3 years of therapy. Eighty-one percent who returned to therapy following a treatment gap re-initiated an oral bisphosphonate, with 18% switching to denosumab. Conclusions: Among seniors initiating oral bisphosphonates, we found that 60% receive at least 3 years of therapy when using an extended follow-up. Studies are needed to examine the benefits and harms of continuing bisphosphonate therapy beyond 3 years.
- Subjects
ONTARIO; OSTEOPOROSIS prevention; RISEDRONATE; DIPHOSPHONATES; ALENDRONATE; TIME; TREATMENT duration; MEDICAL care research; SEX distribution; DRUGS; KAPLAN-Meier estimator; SURVIVAL analysis (Biometry); DESCRIPTIVE statistics; DRUG prescribing; PATIENT compliance; PHYSICIAN practice patterns; OLD age
- Publication
Osteoporosis International, 2021, Vol 32, Issue 7, p1413
- ISSN
0937-941X
- Publication type
Article
- DOI
10.1007/s00198-020-05794-2