title: Risk factors for fracture among current, persistent users of bisphosphonates.
abstract: CONCLUSIONS
  Bisphosphonate therapy reduces fracture risk but does not eliminate fracture occurrence. We determined the fracture incidence and risk factors for fractures among 14,674 bisphosphonate users in a community setting. Bisphosphonate users remained at risk of fracture, and additional measures to prevent fractures in these patients would be beneficial.
  
  
  BACKGROUND
  Bisphosphonate therapy reduces but does not eliminate fracture occurrence. The incidence of fracture and risk factors for fractures among persistent, current users of bisphosphonates in a community setting have not been well studied.
  
  
  METHODS
  We conducted a retrospective cohort study of 14,674 bisphosphonate users in a health maintenance organization. Patients were followed until a 3-month gap in therapy, creating a pool of highly compliant [mean medication possession ratio (MPR) of 94%] current users. We used Cox proportional hazards models to identify risk factors for fractures among these persistent, current users.
  
  
  RESULTS
  There were 867 fractures over the period of observation or 3.7 fractures per 100 users per year. Older patients who take multiple medications, have lower bone mineral density, have a history of prior fracture, and suffer from particular comorbidities (i.e., dementia, chronic kidney disease, and rheumatoid arthritis) are at higher risk of fracture while taking bisphosphonates.
  
  
  CONCLUSIONS
  Persistent, current bisphosphonate users remain at risk of fracture, and additional measures to prevent fractures in these patients would be of benefit.
authors.affiliation: Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA, erin.s.leblanc@kpchr.org.
authors.forename: E S
authors.initials: ES
authors.lastname: LeBlanc
authors.forename: A G
authors.initials: AG
authors.lastname: Rosales
authors.forename: A
authors.initials: A
authors.lastname: Balasubramanian
authors.forename: C D
authors.initials: CD
authors.lastname: O'Malley
authors.forename: O
authors.initials: O
authors.lastname: Egbuna
authors.forename: D
authors.initials: D
authors.lastname: Friess
authors.forename: N A
authors.initials: NA
authors.lastname: Perrin
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; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates