title: Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday.
abstract: Based upon interest in a bisphosphonate drug holiday, we evaluate the risk for hip fracture after bisphosphonate discontinuation. Among women compliant with bisphosphonates for > or = 2 years, the risk of hip fracture was increased after discontinuation, although with higher compliance and a longer duration of preceding bisphosphonate therapy, this risk was attenuated.
  
  
  BACKGROUND
  Recent data suggest that hip fracture risk was not significantly increased among women receiving 5 years of bisphosphonate therapy who were subsequently randomized to placebo. We studied older women compliant with bisphosphonates > or = 2 years to evaluate the risk of hip fracture after bisphosphonate discontinuation.
  
  
  METHODS
  Using administrative databases from a large U.S. healthcare organization, we identified women initiating bisphosphonate therapy compliant (Medication Possession Ratio, MPR > or = 66%) for 2 years. We examined the rate of hip fracture among women who discontinued bisphosphonates versus those who remained on therapy.
  
  
  RESULTS
  At 2 years, 9,063 women were eligible for analysis. Hip fracture incidence among women who discontinued bisphosphonates versus those who did not was 8.43 versus 4.67 per 1000 person years (p = 0.016). The adjusted hazard ratio of hip fracture per 90 days following discontinuation was 1.2 (1.1-1.3). For women with higher compliance at 2 years (MPR > or = 80%) or compliant for 3 years, there were no significant differences in risk associated with discontinuation.
  
  
  CONCLUSIONS
  The rate of hip fracture was increased among women compliant with bisphosphonate therapy for 2 years who subsequently discontinued, suggesting that discontinuation is not advisable under these conditions. This association was attenuated with higher compliance and a longer duration of previous bisphosphonate therapy.
authors.affiliation: Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL, USA. jcurtis@uab.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Curtis
authors.forename: A O
authors.initials: AO
authors.lastname: Westfall
authors.forename: H
authors.initials: H
authors.lastname: Cheng
authors.forename: E
authors.initials: E
authors.lastname: Delzell
authors.forename: K G
authors.initials: KG
authors.lastname: Saag
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004812:Epidemiologic Methods; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates