title: Fractures and mortality in relation to different osteoporosis treatments.
abstract: OBJECTIVE
  Few studies have assessed the effectiveness of different drugs for osteoporosis (OP). We aimed to determine if fracture and mortality rates vary among patients initiating different OP medications.
  
  
  METHODS
  We used the Medicare 5% sample to identify new users of intravenous (IV) zoledronic acid (n=1.674), oral bisphosphonates (n=32.626), IV ibandronate (n=492), calcitonin (n=2.606), raloxifene (n=1.950), or parathyroid hormone (n=549). We included beneficiaries who were ≥65 years of age, were continuously enrolled in fee-for-service Medicare and initiated therapy during 2007-2009. Outcomes were hip fracture, clinical vertebral fracture, and all-cause mortality, identified using inpatient and physician diagnosis codes for fracture, procedure codes for fracture repair, and vital status information. Cox regression models compared users of each medication to users of IV zoledronic acid, adjusting for multiple confounders.
  
  
  RESULTS
  During follow-up (median, 0.8-1.5 years depending on the drug), 787 subjects had hip fractures, 986 had clinical vertebral fractures, and 2.999 died. Positive associations included IV ibandronate with hip fracture (adjusted hazard ratio (HR), 2.37; 95% confidence interval (CI) 1.25-4.51), calcitonin with vertebral fracture (HR=1.59, 95%CI 1.04-2.43), and calcitonin with mortality (HR=1.31; 95%CI 1.02-1.68). Adjusted HRs for other drug-outcome comparisons were not statistically significant.
  
  
  CONCLUSIONS
  IV ibandronate and calcitonin were associated with higher rates of some types of fracture when compared to IV zolendronic acid. The relatively high mortality associated with use of calcitonin may reflect the poorer health of users of this agent.
authors: Department of Epidemiology, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Huifeng
authors: H
authors: Yun
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Elizabeth
authors: E
authors: Delzell
authors: Department of Epidemiology, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Kenneth G
authors: KG
authors: Saag
authors: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Meredith L
authors: ML
authors: Kilgore
authors: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Michael A
authors: MA
authors: Morrisey
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Paul
authors: P
authors: Muntner
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Robert
authors: R
authors: Matthews
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Lingli
authors: L
authors: Guo
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Nicole
authors: N
authors: Wright
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Wilson
authors: W
authors: Smith
authors: Duke University Medical Center and the Durham VA GRECC, Durham, NC, USA.
authors: Cathleen
authors: C
authors: Colón-Emeric
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Duke University Medical Center and the Durham VA GRECC, Durham; and The Carolinas Center for Medical Excellence, Cary NC, USA.
authors: Kenneth W
authors: KW
authors: Lyles
authors: Department of Epidemiology, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Jeffrey R
authors: JR
authors: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D006278:Medicare; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D012307:Risk Factors; D016103:Spinal Fractures / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents