ArticleArchives of osteoporosis2026
Shifting bisphosphonate prescribing patterns for fracture prevention: a 24-year national surveillance of men in the U.S. Veterans Health Administration.
Article in Archives of osteoporosis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
In the U.S's largest integrated health system, during a 24-year period (1999-2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty. PURPOSE: To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.
methodsU.S. national Veterans Health Administration (VHA) data (1999-2022) were queried to identify men aged ≥ 50 years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65 years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.
resultsA total of 298,340 men initiated a BP during 1999-2022, of whom 233,857 (78.4%) were aged ≥ 65 years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004-2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged < 65 years declined from a peak of 28.2% during the middle time period (2008-2012) to a nadir of 13.3% during the final years (2018-2022, p < 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999-2002 to 24.5% in 2018-2022 (p < 0.001). Notably, over half of the men who initiated BP during 1999-2002 were classified as non-frail, whereas in the most recent time period (2018-2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (p < 0.001).
conclusionIn the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.
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