title: Bisphosphonate use and subsequent hip fracture in South Korea.
abstract: We determined the incidence of second hip fracture and evaluated whether compliant and persistent users of bisphosphonate had a lower incidence of second hip fracture after prior hip fracture, from a national claim registry.
  
  
  BACKGROUND
  Bisphosphonate is prescribed worldwide for the primary prevention of osteoporotic fracture. However, the association between adherent use of bisphosphonate and prevention of second hip fracture is unclear. Our purpose was to determine whether the adherent use of bisphosphonate was associated with a decreased risk of second hip fracture in South Korea, using a nationwide database.
  
  
  METHODS
  From 2007 to 2011, first and second hip fractures were identified using the ICD-10 and procedure code form from the nationwide database of the Health Insurance Review and Assessment Service. Compliant use of bisphosphonate was defined as a patient medication possession ratio of 80 or more. Persistent users were defined patients with a refill gap of 30 days or less. We compared the incidence of second hip fracture in compliant and persistent users and non-users.
  
  
  RESULTS
  Among 59,782 patients with first hip fracture, in this study, 1,336 second hip fracture occurred after the initial hip fracture during the study period. The mean age at the first hip fracture was 75.4 years (range, 50 to 100 years). The cumulative 1-year, 2-year, and 3-year incidence of second hip fracture was 1.0% (552/59,782), 1.9% (1,123/59,782), and 2.2% (1,336/59,782), respectively. After multivariate analysis, compliant and persistent use of bisphosphonate was significantly independent protectors for second hip fracture (HR, 0.595; 95% CI, 0.400-0.885; HR, 0.433; 95% CI, 0.327-0.573, respectively).
  
  
  CONCLUSIONS
  Compliant and persistent use of bisphosphonate decreases the risk of second hip fracture, in terms of secondary prevention.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Korean Society for Bone and Mineral Research, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, South Korea.
authors.forename: Y-K
authors.initials: YK
authors.lastname: Lee
authors.forename: Y-C
authors.initials: YC
authors.lastname: Ha
authors.forename: H J
authors.initials: HJ
authors.lastname: Choi
authors.forename: S
authors.initials: S
authors.lastname: Jang
authors.forename: C
authors.initials: C
authors.lastname: Park
authors.forename: Y-T
authors.initials: YT
authors.lastname: Lim
authors.forename: C S
authors.initials: CS
authors.lastname: Shin
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D055502:Secondary Prevention; D017678:Sex Distribution; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates