Bone health-related factors and the use of bisphosphonates in community setting--15-year follow-up study.
The present study investigated the bone health related factors that were associated with the use of bisphosphonates (BP) among 2,050 postmenopausal Finnish women. Low BMD + low trauma energy fracture was the strongest determinant of BP use, while other secondary causes of osteoporosis were less strongly related with BP use. BP use was associated with reduced femoral neck (FN) and lumbar spine (LS) bone loss rate.


BACKGROUND
The aim was to identify bone health related factors associated with the use of BP in a community setting.


METHODS
A population-based sample of 2,050 Finnish postmenopausal women was measured with dual X-ray absorptiometry at the FN and LS in 1989, 1994, 1999 and 2004, and information on osteoporosis risk factors, including low-trauma energy fractures, were collected with postal inquiries. Self-reported use of BP in 2004 was considered as the end point variable.


RESULTS
Among BP users, 12% had T-score > -2.0 SD and no fracture during follow-up (FU). In women without any bone medication, 26% had T-score < -2.0 SD or low-trauma energy fracture or both during the FU. In BP users, a significant reduction in FN and LS bone loss rate, cumulative with duration of use, was observed in ANCOVA (p < 0.001). Among BP users, there was a significantly higher proportion of women with several independent risk factors for osteoporosis and more spine and humerus fractures but less ankle fractures. T-score < -2 SD combined with low-trauma energy fracture was significantly related to the use of BPs (p < 0.001, OR = 15.96) and T-score < -2 SD was a stronger predictor of BP use (p < 0.001, OR = 13.29) than fracture (p > 0.05, OR = 1.35) in multivariate logistic regression. Other factors related with BP use were vitamin D use (p = 0.001, OR = 2.27), high number of medications (p < 0.001, OR = 1.26) and rheumatoid arthritis (p < 0.05, OR 2.55).


CONCLUSIONS
These findings reveal the recent bone health-related indications for BP prescription.
Sirola
J
J
Bone and Cartilage Research Unit (BCRU), University of Kuopio, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland. joonas.sirola@kuh.fi
Salovaara
K
K
Rikkonen
T
T
Kärkkäinen
M
M
Tuppurainen
M
M
Jurvelin
J S
JS
Honkanen
R
R
Kröger
H
H
D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
D050071:Bone Density Conservation Agents; D004164:Diphosphonates