title: Impact of noncompliance with alendronate and risedronate on the incidence of nonvertebral osteoporotic fractures in elderly women.
abstract: OBJECTIVE
  To evaluate the association between noncompliance with alendronate and risedronate and the risk of nonvertebral osteoporotic fracture in community-dwelling elderly women.
  
  
  METHODS
  A nested case-control study was conducted using the Quebec administrative health databases. To be included in the cohort, women needed to be aged > or = 68 years and to have initiated treatment with alendronate or risedronate between 1 January 2002 and 31 March 2005. Cases consisted of all women with an incident nonvertebral osteoporotic fracture occurring > or = 1 year after initiation of therapy. Each case was matched with up to 20 controls using incidence density sampling, according to age (+/- 1 year) and follow-up duration. A woman was noncompliant if she had a medication possession ratio (MPR) <80% for total follow-up duration. Rate ratios (RR) for fracture were estimated through conditional logistic regression analysis, adjusting for potential confounders.
  
  
  RESULTS
  Among the 30 259 women included in the cohort, 1036 nonvertebral fracture cases were identified and were matched to 20 069 controls. Compared with women with a MPR > or = 80%, those with a MPR < 80% had a greater risk of nonvertebral fracture [adjusted RR 1.27, 95% confidence interval (CI) 1.12, 1.44]. Considering hip fracture only, the multivariate model yielded similar results, (adjusted RR 1.28, 95% CI 1.02, 1.61).
  
  
  CONCLUSIONS
  Among community-dwelling elderly women, noncompliance with alendronate or risedronate is associated with an increased risk of nonvertebral fracture.
authors.affiliation: Faculties of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Blouin
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
authors.forename: Yola
authors.initials: Y
authors.lastname: Moride
authors.forename: Louis-Georges
authors.initials: LG
authors.lastname: Ste-Marie
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Fernandes
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D000068296:Risedronic Acid; D012307:Risk Factors; D016312:Treatment Refusal
chemical_list: D050071:Bone Density Conservation Agents; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate