Effect of Risedronate on the Risk of Hip Fracture in Elderly Women

McClung, Michael R.; Geusens, Piet; Miller, Paul D.; Zippel, H; Bensen, W.; Roux, Christian; Adami, Silvano; Fogelman, Ignac; Diamond, Terrence; Eastell, Richard; Meunier, Pierrre J.; Reginster, Jean‐Yves

doi:10.1097/00006254-200107000-00020

Cited by 117 publications

(143 citation statements)

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“…The placebo arms of bisphosphonate trials, with durations of 3 to 4 years, show hip fracture incidence per 100,000/year of 750 (31) and 833 (30) (patients with vertebral fractures), 1390 (32) (age 70-79 years with osteoporosis) and 4200 (32) (age older than 80 years with osteoporosis). In these studies the hip fracture rates were reduced by 20% to 50% with bisphosphonate therapy.…”

Section: Discussionmentioning

confidence: 99%

Incidence of atypical nontraumatic diaphyseal fractures of the femur

Dell

Adams

Greene

et al. 2012

Journal of Bone and Mineral Research

389

278

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Bisphosphonates reduce the rate of osteoporotic fractures in clinical trials and community practice. ''Atypical'' nontraumatic fractures of the diaphyseal (subtrochanteric or shaft) part of the femur have been observed in patients taking bisphosphonates. We calculated the incidence of these fractures within a defined population and examined the incidence rates according to duration of bisphosphonate use. We identified all femur fractures from January 1, 2007 until December 31, 2011 in 1,835,116 patients older than 45 years who were enrolled in the Healthy Bones Program at Kaiser Southern California, an integrated health care provider. Potential atypical fractures were identified by diagnostic or procedure codes and adjudicated by examination of radiographs. Bisphosphonate exposure was derived from internal pharmacy records. The results showed that 142 patients had atypical fractures; of these, 128 had bisphosphonate exposure. There was no significant correlation between duration of use (5.5 AE 3.4 years) and age (69.3 AE 8.6 years) or bone density (T-score À2.1 AE 1.0). There were 188,814 patients who had used bisphosphonates. The age-adjusted incidence rates for an atypical fracture were 1.78/100,000/year (95% confidence interval [CI], 1.5-2.0) with exposure from 0.1 to 1.9 years, and increased to 113.1/100,000/year (95% CI, 69.3-156.8) with exposure from 8 to 9.9 years. We conclude that the incidence of atypical fractures of the femur increases with longer duration of bisphosphonate use. The rate is much lower than the expected rate of devastating hip fractures in elderly osteoporotic patients. Patients at risk for osteoporotic fractures should not be discouraged from initiating bisphosphonates, because clinical trials have documented that these medicines can substantially reduce the incidence of typical hip fractures. The increased risk of atypical fractures should be taken into consideration when continuing bisphosphonates beyond 5 years. ß

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Section: Discussionmentioning

confidence: 99%

Incidence of atypical nontraumatic diaphyseal fractures of the femur

Dell

Adams

Greene

et al. 2012

Journal of Bone and Mineral Research

389

278

View full text Add to dashboard Cite

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“…(11) Furthermore, risedronate significantly reduced the risk of hip and nonvertebral fractures in women aged 70 to 79 years with femoral neck BMD T-scores < À4.0 but did not significantly reduce fracture risk in women aged 80 years and older with fall-related risk factors for fracture. (12,13) With zoledronic acid, on the other hand, there were no significant treatment interactions for nonvertebral fractures. (7) Denosumab is an antiresorptive drug with a unique mechanism of action.…”

Section: Introductionmentioning

confidence: 91%

Effect of denosumab treatment on the risk of fractures in subgroups of women with postmenopausal osteoporosis

McClung

Boonen

Törring

et al. 2011

Journal of Bone and Mineral Research

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Denosumab reduces the risk of new vertebral and nonvertebral fractures. Previous trials suggest that the efficacy of antiresorptives on fractures might differ by patients' characteristics, such as age, bone mineral density (BMD), and fracture history. In the FREEDOM study, 7808 women aged 60 to 90 years with osteoporosis were randomly assigned to receive subcutaneous injections of denosumab (60 mg) or placebo every 6 months for 3 years. New vertebral and nonvertebral fractures were radiologically confirmed. Subgroup analyses described in this article were prospectively planned before study unblinding to evaluate the effect of denosumab on new vertebral and nonvertebral fractures across various subgroups. Compared with placebo, denosumab decreased the risk of new vertebral fractures in the overall study population over 3 years. This effect did not significantly differ for any of the nine subgroups analyzed ( p > 0.09 for all potential interactions). Denosumab also reduced all nonvertebral fractures by 20% in the full study cohort over 3 years. This risk reduction was statistically significant in women with a baseline femoral neck BMD T-score À2.5 but not in those with a T-score > À2.5; in those with a body mass index (BMI) < 25 kg/m 2 but not ! 25 kg/m 2 ; and in those without but not with a prevalent vertebral fracture. These differential treatment effects were not explained by differences in BMD responses to denosumab. Denosumab 60 mg administered every 6 months for 3 years in women with osteoporosis reduced the risk of new vertebral fractures to a similar degree in all subgroups. The effect of denosumab on nonvertebral fracture risk differed by femoral neck BMD, BMI, and prevalent vertebral fracture at baseline. ß

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“…Since fractures are less common in men, all major pharmaceutical interventions for primary prevention of fractures were exclusively tested in postmenopausal women, with more than 40,000 women included in these studies [2,5,7,8,14,24,25]. A smaller study involving men established the effectiveness of these therapies on surrogate markers, such as increased BMD and bone turnover.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Gender Differences in Osteoporosis and Fractures

Cawthon

2011

Clinical Orthopaedics &Amp; Related Research

237

153

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Background Osteoporosis is generally thought of as a ''woman's disease'' because the prevalence of osteoporosis and the rate of fractures are much higher in postmenopausal women than in older men. However, the absolute number of men affected by osteoporosis and fractures is large, as at least 2.8 million men in the United States are thought to have osteoporosis. Questions/purposes The purposes of this review are to (1) highlight gender differences in osteoporosis and fracture risk, (2) describe disparities in treatment and outcomes after fractures between men and women, and (3) propose solutions to reducing disparities in treatment and prevention. Methods A literature survey was conducted using MEDLINE with a variety of search terms and using references from the author's personal collection of articles. A formal search strategy and exclusion criteria were not employed and the review is therefore selective. Where are we now? Postmenopausal women have a higher prevalence of osteoporosis and greater incidence of fracture than older men. Despite the higher fracture risk in postmenopausal women, older men tend to have worse outcomes after fracture and poorer treatment rates, although less is known about the disease course in men.Multifaceted interventions to improve the screening and treatment for osteoporosis were recently developed. Where do we need to go? Improvement in treatment rates of those at risk, regardless of gender, is an important goal in osteoporosis management. How do we get there? Further development and evaluation of cost-effective, multifaceted interventions for screening and treatment of osteoporosis and fractures are needed; such interventions will likely improve the primary prevention of fractures.

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Effect of Risedronate on the Risk of Hip Fracture in Elderly Women

Cited by 117 publications

References 0 publications

Incidence of atypical nontraumatic diaphyseal fractures of the femur

Incidence of atypical nontraumatic diaphyseal fractures of the femur

Effect of denosumab treatment on the risk of fractures in subgroups of women with postmenopausal osteoporosis

Gender Differences in Osteoporosis and Fractures

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