title: Population-based study of the effectiveness of bone-specific drugs in reducing the risk of osteoporotic fracture.
abstract: OBJECTIVE
  Evidence supports bone-specific drugs (BSDs) efficacy in the fracture risk reduction. But treatment rates for osteoporosis among high-risk patients are far below the recommended guidelines. A major concern about BSDs is the lack of adherence with treatment.
  
  
  OBJECTIVE
  To determine if BSDs decrease fracture risk in high-risk elderly women in real clinical setting.
  
  
  METHODS
  A nested case-control design was used in a cohort of elderly women from the Quebec health databases. Women enter into the cohort if they are 70 years or older between 1995 and 2003. Nested case-controls were designed for women with a diagnosis of osteoporosis (OP) and for those with a prior fracture. All cases of fractures occurring during follow-up were matched with 10 randomly selected controls based on age, time period, bone mass density testing, and having a diagnosis of OP or a prior fracture. Use of BSDs before the index date was categorized as follows: short-term (< or =1 year), intermediate-term (>1 and < or = 3 years), and long-term (>3 years). We used an adjusted conditional logistic regression model to assess BSD effect on fracture.
  
  
  RESULTS
  Among 3170 women who had a fracture, of these women, 1824 had OP and 1346 had a prior fracture. Only long-term exposure to BSDs among women with OP reduced the fracture risk by 16% (odds ratio: 0.84; 0.73-0.97). Among women with OP, a high number of medical services or use of anticonvulsants or narcotics increased the fracture risk by 12-73%. Among women with a prior fracture, a high number of medical services or risk of fall or use of benzodiazepines, antidepressants, or narcotics increased the fracture risk by 23-77%.
  
  
  CONCLUSIONS
  The incidence of fractures decreased by 16% among women with OP when more than 80% of BSDs was used for at least 3 years. Among women with a prior fracture, fracture risk reduction was not significant. Exposure to BSDs among women with a prior fracture is troubling, given that only approximately 12% of these individuals were being treated, and only 2% was using BSDs for the long term.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada. sylvie.perreault@umontreal.ca
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.forename: Yola
authors.initials: Y
authors.lastname: Moride
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.forename: Louis-Georges
authors.initials: LG
authors.lastname: Ste-Marie
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Fernandès
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D000928:Antidepressive Agents / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D011792:Quebec; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents; D050071:Bone Density Conservation Agents; D001569:Benzodiazepines