Treatment Persistence and Medication Switch Associated With Subsequent Fractures After Osteoporotic Fractures

Sung-Yen Lin; Wei-Ju Chen; Chieh-Ko Ku; Yi-Ming Chen; Chung-Hwan Chen; Li-Nien Chien

doi:10.1210/clinem/dgad449

Treatment Persistence and Medication Switch Associated With Subsequent Fractures After Osteoporotic Fractures

J Clin Endocrinol Metab. 2023 Dec 21;109(1):e200-e208. doi: 10.1210/clinem/dgad449.

Authors

Sung-Yen Lin^{1

2

3

4

5}, Wei-Ju Chen⁶, Chieh-Ko Ku⁶, Yi-Ming Chen^{7

8}, Chung-Hwan Chen^{1

2

3

4

9

10

11

12

13}, Li-Nien Chien¹⁴

Affiliations

¹ Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
² Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
³ Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
⁴ Division of Adult Reconstruction Surgery, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
⁵ Department of Orthopedics, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
⁶ Medical, Amgen Taiwan Limited, Taipei 110, Taiwan.
⁷ Division of Allergy, Immunology, and Rheumatology, Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
⁸ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.
⁹ Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
¹⁰ Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan.
¹¹ Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
¹² Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan.
¹³ Graduate Institute of Materials Engineering, College of Engineering, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan.
¹⁴ Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.

PMID: 37526298
DOI: 10.1210/clinem/dgad449

Abstract

Context: Despite prevalent anti-osteoporosis medication (AOM) switching in real-world osteoporosis management, few studies have evaluated the impact of persistent AOM treatment, allowing for AOM switching, on the risk of subsequent fracture.

Objective: We examined the association between persistence in AOM and subsequent fractures, allowing for medication switching among patients with osteoporotic fractures.

Methods: This retrospective cohort study used Taiwan National Health Insurance claims data to select patients who initiated AOM between 2013 and 2016. Treatment persistence was defined as use of any AOM on a given day of interest with a 45-day grace period. Medication switch was allowed for persistence if remaining on treatment. AOMs with long-lasting inhibition of bone resorption (zoledronate and denosumab) were categorized as high-potency; others as low-potency. Multivariate Cox models were used to evaluate risk of subsequent fractures ≥3 months after initiating AOM.

Results: A total of 119 473 patients were included (mean [SD] follow-up 46.4 [15.6] months), and 26.8% switched from the index AOM. Within 1 year, 52% remained persistent with AOM. Compared to patients with persistent AOM, those not persistent had higher risk of subsequent hip (adjusted hazard ratio [aHR] = 1.31; 95% CI, 1.21-1.42), vertebral (aHR = 1.17; 95% CI, 1.13-1.22), and radius fractures (aHR = 1.16; 95% CI, 1.08-1.25). Patients with persistent AOM who switched from high- to low-potency AOM had higher risk of subsequent vertebral fractures than those with persistent AOM and no potency switch (aHR = 1.28; 95% CI, 1.02-1.60).

Conclusion: Patients with non-persistent AOM had higher risk of subsequent fractures than persistent users when allowing AOM switch. Switching AOM potency may influence the risk of subsequent vertebral fractures and warrants further investigation.

Keywords: anti-osteoporosis medication; medication switching; persistence; retrospective cohort study; subsequent fracture.

MeSH terms

Bone Density Conservation Agents* / adverse effects
Humans
Osteoporosis* / complications
Osteoporosis* / drug therapy
Osteoporosis* / epidemiology
Osteoporotic Fractures* / chemically induced
Osteoporotic Fractures* / epidemiology
Retrospective Studies
Spinal Fractures* / complications
Spinal Fractures* / etiology

Substances

Bone Density Conservation Agents

Grants and funding

Amgen Taiwan Limited