title: Long-term persistence with anti-osteoporosis drugs after fracture.
abstract: Long-term persistence with anti-osteoporosis drugs and determinants for discontinuation among fracture patients were examined. Persistence was 75.0 and 45.3 % after 1 and 5 years, respectively. Those aged ≥80 years were at increased risk of early discontinuation. Within 1 year after discontinuation, 24.3 % restarted therapy, yet 47.0 % persisted for 1 year.
  
  
  BACKGROUND
  The risk of osteoporotic fracture can effectively be reduced with use of anti-osteoporosis drugs. However, little is known about persistence with these drugs after fracture where subsequent fracture risk is high. The aims were to determine long-term persistence with anti-osteoporosis drugs among fracture patients, including its determinants, and to describe restart and subsequent persistence.
  
  
  METHODS
  A cohort study was conducted within the Dutch PHARMO Database Network. Patients aged ≥50 years (n = 961) who received anti-osteoporosis drugs within 1 year after fracture, but not in the preceding year, were included (2002-2011). Persistence (defined as the proportion on treatment) and the proportion restarting after discontinuation were estimated using Kaplan-Meier analyses. Time-dependent Cox regression was used to identify determinants of non-persistence including age, sex, initial dosage regime, fracture type, comorbidities, and drug use.
  
  
  RESULTS
  Persistence with anti-osteoporosis drugs was 75.0 % (95 % confidence interval (CI) 72.0-77.7) and 45.3 % (95 % CI 40.4-50.0) after 1 and 5 years, respectively. A significant determinant of non-persistence was age ≥80 years (reference 50-59 years: adjusted hazard ratio [adj. HR] 1.65; 95 % CI 1.15-2.38). This effect was not constant over time (≤360 days following initiation: adj. HR 2.07; 95 % CI 1.27-3.37; >360 days: adj. HR 1.08; 95 % CI 0.62-1.88). Within 1 year after discontinuation, 24.3 % (95 % CI 20.1-29.2) restarted therapy, yet 47.0 % persisted for 1 year.
  
  
  CONCLUSIONS
  This study identified suboptimal persistence with anti-osteoporosis drugs among fracture patients. Major target groups for measures aimed to improve persistence may be those aged >80 years and those restarting therapy.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Klop
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands.
authors.forename: P M J
authors.initials: PM
authors.lastname: Welsing
authors.affiliation: Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: P J M
authors.initials: PJ
authors.lastname: Elders
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Overbeek
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: Souverein
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands.|Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Burden
authors.affiliation: Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands.|Department of Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: H A W
authors.initials: HA
authors.lastname: van Onzenoort
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands.
authors.forename: H G M
authors.initials: HG
authors.lastname: Leufkens
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands.
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands. f.devries@uu.nl.|Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands. f.devries@uu.nl.|MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK. f.devries@uu.nl.
authors.forename: F
authors.initials: F
authors.lastname: de Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents
keywords: Epidemiology; Fracture prevention; Osteoporosis; Persistence; Therapeutics
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