ArticleJournal of the American Geriatrics Society2019
Effect of Bisphosphonates on Fracture Outcomes Among Frail Older Adults.
Article in Journal of the American Geriatrics Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled 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.
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.
Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Alzheimer's disease and its associated risk of bone fractures: a narrative review.Frontiers in endocrinology · 2023Pooled it
- Time to Benefit of Bisphosphonate Therapy for the Prevention of Fractures Among Postmenopausal Women With Osteoporosis: A Meta-analysis of Randomized Clinical Trials.JAMA internal medicine · 2022Pooled it
- Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention.Journal of bone and mineral metabolism · 2020Pooled it
- Effectiveness and Safety of Pharmacological Therapy for Osteoporosis in Frail Elderly Individuals: Systematic Review and Meta-Analysis.Health science reports · 2026Review
- Exposure to Drugs Related to Injurious Falls Risk and to Bisphosphonates in Nursing Home Residents With Recent Fracture.Journal of the American Medical Directors Association · 2026Article
- Treatment Considerations for Severe Osteoporosis in Older Adults.Drugs & aging · 2025Review
- Association between dietary protein intake and bone mineral density based on NHANES 2011-2018.Scientific reports · 2025Article
- Article
- The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies.American journal of epidemiology · 2024Review
- Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents.Journal of the American Geriatrics Society · 2023Article
- Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics.International journal of molecular sciences · 2023Review
- Screening of Fracture Risk and Osteoporosis Among Older Long-term Care Residents: A Prospective Study.The journal of nutrition, health & aging · 2023Article
- Controversies in Osteoporosis Treatment of Nursing Home Residents.Journal of the American Medical Directors Association · 2022Review
- Osteoporosis Medications Prevent Subsequent Fracture in Frail Older Adults.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- A Rare Case of an Intertrochanteric Hip Fracture Combined with an Ipsilateral Incomplete Atypical Femoral Fracture Treated with a Long Gamma Intramedullary Nail.Journal of orthopaedic case reports · 2022Article
- Changing trends in hip fracture epidemiology in the Republic of Ireland: a follow-up study.Archives of osteoporosis · 2022Article
- Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis.Archives of osteoporosis · 2022Article
- Total Hip Bone Mineral Density as an Indicator of Fracture Risk in Bisphosphonate-Treated Patients in a Real-World Setting.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Observational
- Differences in the baseline characteristics, management and outcomes of patients with hip fractures depending on their pre-fracture place of residence: the Spanish National Hip Fracture Registry (RNFC) cohort.European geriatric medicine · 2021Article
- Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people.Aging clinical and experimental research · 2021Review
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundBisphosphonates are seldom used in frail, older adults, in part due to lack of direct evidence of efficacy in this population and increasing concerns about safety.
objectiveWe estimated the effects of bisphosphonates on hip fractures, nonvertebral fractures, and severe esophagitis among frail, older adults.
designPopulation-based retrospective cohort using 2008 to 2013 linked national Minimum Data Set assessments; Online Survey Certification and Reporting System records; and Medicare claims.
settingUS nursing homes (NHs).
participantsLong-stay NH residents 65 years and older without recent osteoporosis medication use (N = 24,571). Bisphosphonate initiators were 1:1 propensity score matched to calcitonin initiators (active comparator). MEASUREMENTS: Hospitalized hip fracture, nonvertebral fracture, and esophagitis outcomes were measured using part A claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated, controlling for over 100 baseline characteristics.
resultsThe matched cohort included 5209 new bisphosphonate users and an equal number of calcitonin users (mean age [SD] = 85 [8] years; 87% female; 52% moderate-severe cognitive impairment). Over a mean follow-up of 2.5 (SD = 1.7) years, 568 residents (5.5%) had a hip fracture, 874 (8.4%) had a nonvertebral fracture, and 199 (1.9%) had a hospitalized esophagitis event. Users of bisphosphonates were less likely than calcitonin users to experience hip fracture (HR = 0.83; 95% CI = 0.71-0.98), with an average gain in time without fracture of 28.4 days (95% CI = 6.0-50.8 days). Bisphosphonate and calcitonin users had similar rates of nonvertebral fracture (HR = 0.91; 95% CI = 0.80-1.03) and esophagitis events (HR = 1.11; 95% CI = 0.84-1.47). The effects of bisphosphonates on fractures and esophagitis were generally homogeneous across subgroups, including those defined by age, sex, history of prior fracture, and baseline fracture risk.
conclusionsUse of bisphosphonates is associated with a meaningful reduction in hip fracture among frail, older adults, but little difference in nonvertebral fracture or severe esophagitis. J Am Geriatr Soc 67:768-776, 2019.
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Registered trials
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.