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Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice

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Abstract

Summary

This study aims to estimate bisphosphonate effectiveness by comparing fracture incidence over time on therapy in glucocorticoid-induced osteoporosis (GIO). From this observational study, alendronate and risedronate decreased clinical vertebral and nonvertebral fractures over time. The effectiveness of each bisphosphonate is consistent with their efficacies demonstrated on surrogate markers in randomized controlled trials (RCTs).

Introduction

This study aims to estimate bisphosphonate effectiveness by comparing fracture incidence over time on therapy with fracture incidence during a short period after starting a therapy.

Methods

The study population was a subgroup of a larger cohort study comprising two cohorts of women aged ≥65 years, prescribed with alendronate or risedronate. Within the two study cohorts, 11,007 women were identified as having received glucocorticoids. Within each cohort, the baseline incidence of clinical fractures at nonvertebral and vertebral sites was defined by the initial 3-month period after starting therapy. Relative to these baseline data, we then compared the fracture incidence during the subsequent 12 months on therapy.

Results

The baseline incidence of clinical nonvertebral and vertebral fractures was similar in the alendronate cohort (5.22 and 5.79/100 person-years, respectively) and in the risedronate cohort (5.51 and 5.68/100 person-years, respectively). Relative to the baseline incidence, fracture incidence was significantly lower in the subsequent 12 months in both cohorts of alendronate (33 % lower at nonvertebral sites and 59 % at vertebral sites) and risedronate (28 % lower at nonvertebral sites and 54 % at vertebral sites).

Conclusion

From this observational study not designed to compare drugs, both alendronate and risedronate decreased clinical vertebral and nonvertebral fractures over time. The reductions observed in fracture incidence, within each cohort, suggest that the effectiveness of each bisphosphonate in clinical practice is consistent with their efficacies demonstrated on surrogate markers in randomized controlled trials.

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Acknowledgments

Funding for this study was provided by Warner Chilcott Pharmaceuticals and Sanofi.

Conflicts of interest

Dr. Thomas reports receiving consulting or advisory committee fees from Amgen, Lilly, Merck, Novartis, Warner Chilcott, Roche/GlaxoSmithKline, and Servier; and grant support from Lilly, Merck, Novartis, and Servier. Dr. Ringe reports receiving advisory committee fees from Amgen, Merck, and Servier. Dr. Gold reports receiving consulting or advisory committee fees from Amgen, Eli Lilly, GlaxoSmithKline, Merck, and Sanofi; and serves on speaker’s bureaus for Amgen, Eli Lilly, Warner Chilcott, Roche, and Sanofi. Dr. Abelson has no conflict of interest to declare. Dr. Horlait and Atlan are employees of Warner Chilcott, and Dr. Lange was an employee of Procter & Gamble.

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Authors and Affiliations

  1. INSERM U1059, Rheumatology Department, University Hospital of Saint-Etienne, 42055, Saint-Etienne Cedex 2, France

    T. Thomas

  2. Warner Chilcott, Paris, France

    S. Horlait & P. Atlan

  3. Medizinische Klinik IV (Osteology, Rheumatology), Klinikum Leverkusen, University of Cologne, Cologne, Germany

    J. D. Ringe

  4. Cleveland Clinic Foundation, Cleveland, OH, 44195, USA

    A. Abelson

  5. Duke University Medical Center, Durham, NC, 27710, USA

    D. T. Gold

  6. Procter & Gamble, Cincinnati, OH, 45202, USA

    J. L. Lange

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  1. T. Thomas
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  2. S. Horlait
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  3. J. D. Ringe
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  4. A. Abelson
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  7. J. L. Lange
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Correspondence to T. Thomas.

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Thomas, T., Horlait, S., Ringe, J.D. et al. Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice. Osteoporos Int 24, 263–269 (2013). https://doi.org/10.1007/s00198-012-2060-4

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  • DOI: https://doi.org/10.1007/s00198-012-2060-4

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