Evidence map›Paper›PMID 23761350›Full record

Observational studyJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2014

Predictors of fracture while on treatment with oral bisphosphonates: a population-based cohort study.

Daniel Prieto-Alhambra, Aina Pagès-Castellà, Gemma Wallace, M Kassim Javaid, Andrew Judge, Xavier Nogués, Nigel K Arden, Cyrus Cooper, Adolfo Diez-Perez

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Relationship between baseline characteristics and response to risedronate treatment for osteoporosis: data from three Japanese phase III trials.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017
    Pooled it
  2. Surgical treatment in spine Paget's disease: a systematic review.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2016
    Pooled it
  3. Review
  4. Review
  5. Proton Pump Inhibitors and Bone Health: An Update Narrative Review.International journal of molecular sciences · 2022
    Review
  6. One- and 2-year incidence of osteoporotic fracture: a multi-cohort observational study using routinely collected real-world data.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022
    Observational
  7. Article
  8. Review
  9. Article
  10. Article
  11. Vitamin D supplementation after the menopause.Therapeutic advances in endocrinology and metabolism · 2020
    Review
  12. Article
  13. Comparison of Osteoporosis Pharmacotherapy Fracture Rates: Analysis of a MarketScanInternational journal of endocrinology and metabolism · 2018
    Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Review
  19. Predictors of re-fracture amongst patients managed within a secondary fracture prevention program: a 7-year prospective study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2015
    Observational
  20. Risk factors for fracture among current, persistent users of bisphosphonates.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2015
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Daniel Prieto-AlhambraUnitat de Recerca en Fisiopatologia Òssia i Articular (URFOA-IMIM) and Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Parc de Salut Mar, Barcelona, Spain; National Institute for Health Research (NIHR) Biomedical Research Unit, Musculoskeletal Epidemiology Group, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group, Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
Aina Pagès-Castellà
Gemma Wallace
M Kassim Javaid
Andrew Judge
Xavier Nogués
Nigel K Arden
Cyrus Cooper
Adolfo Diez-Perez

Funding

Department of Health RP-PG-0407-10064Medical Research Council G0400491Medical Research Council MC_U147585819Medical Research Council MC_UP_A620_1014Medical Research Council MC_UU_12011/1
6 · The paper itself

Abstract

Although oral bisphosphonates (BPs) are highly effective in preventing fractures, some patients will fracture while on treatment. We identified predictors of such fractures in a population-based cohort of incident users of oral BPs. We screened the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database to identify new users of oral BPs in 2006-2007. SIDIAP includes pharmacy invoice data and primary care electronic medical records for a representative 5 million people in Catalonia (Spain). Exclusion criteria were the following: Paget disease; <40 years of age; and any antiosteoporosis treatment in the previous year. A priori defined risk factors included age, gender, body mass index, vitamin D deficiency, smoking, alcohol drinking, preexisting comorbidities, and medications. Fractures were considered if they appeared at least 6 months after treatment initiation. "Fractures while on treatment" were defined as those occurring among participants persisting for at least 6 months and with an overall high compliance (medication possession ratio ≥80%). Fine and Gray survival models accounting for competing risk with therapy discontinuation were fitted to identify key predictors. Only 7449 of 21,385 (34.8%) participants completed >6 months of therapy. Incidence of fracture while on treatment was 3.4/100 person-years (95% confidence interval [CI], 3.1-3.7). Predictors of these among patients persisting and adhering to treatment included: older age (subhazard ratio [SHR] for 60 to <80 years, 2.18 [95% CI, 1.70-2.80]; for ≥80 years, 2.5 [95% CI, 1.82-3.43]); previous fracture (1.75 [95% CI, 1.39-2.20] and 2.49 [95% CI, 1.98-3.13], in the last 6 months and longer, respectively); underweight, 2.11 (95% CI, 1.14-3.92); inflammatory arthritis, 1.46 (95% CI, 1.02-2.10); use of proton pump inhibitors (PPIs), 1.22 (95% CI, 1.02-1.46); and vitamin D deficiency, 2.69 (95% CI, 1.27-5.72). Even among high compliers, 3.4% of oral BP users will fracture every year. Older age, underweight, vitamin D deficiency, PPI use, previous fracture, and inflammatory arthritides increase risk. Monitoring strategies and/or alternative therapies should be considered for these patients.

Indexed as

Administration, OralAdultAgedAged, 80 and overBody Mass IndexCohort StudiesDatabases, FactualDiphosphonatesFemaleFractures, BoneHip FracturesHumansIncidenceMaleMiddle AgedPatient ComplianceDiphosphonatesProton Pump InhibitorsBISPHOSPHONATESBONEEPIDEMIOLOGYFRACTURES

Identifiers

PMID23761350
PMCPMC3867340

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.