Skip to main content

Advertisement

SpringerLink
Log in

Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.

Introduction

The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.

Methods

A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.

Results

Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.

Conclusions

AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Weinstein RS (2011) Clinical practice. Glucocorticoid-induced bone disease. N Engl J Med 365:62–70

    Article  CAS  PubMed  Google Scholar 

  2. Lekamwasam S, Adachi JD, Agnusdei D, Bilezikian J, Boonen S, Borgstrom F, Cooper C, Diez Perez A, Eastell R, Hofbauer LC, Kanis JA, Langdahl BL, Lesnyak O, Lorenc R, McCloskey E, Messina OD, Napoli N, Obermayer-Pietsch B, Ralston SH, Sambrook PN, Silverman S, Sosa M, Stepan J, Suppan G, Wahl DA, Compston JE, Joint IOF-ECTS GIO Guidelines Working Group (2012) A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int 23:2257–2276

    Article  CAS  PubMed  Google Scholar 

  3. Overman RA, Yeh JY, Deal CL (2013) Prevalence of oral glucocorticoid usage in the United States: a general population perspective. Arthr Care Res (Hoboken) 65:294–298

    Article  Google Scholar 

  4. Fardet L, Petersen I, Nazareth I (2011) Description of oral glucocorticoid prescriptions in general population. Rev Med Interne 32:594–599

    Article  CAS  PubMed  Google Scholar 

  5. van Staa TP, Leufkens HGM, Abenhaim L, Begaud B, Zhang B, Cooper C (2000) Use of oral corticosteroids in the United Kingdom. QJM 93:105–111

    Article  PubMed  Google Scholar 

  6. Feldstein AC, Elmer PJ, Nichols GA, Herson M (2005) Practice patterns in patients at risk for glucocorticoid-induced osteoporosis. Osteoporos Int 16:2168–2174

    Article  CAS  PubMed  Google Scholar 

  7. Walsh LJ, Wong CA, Pringle M, Tattersfield AE (1996) Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. Br Med J 313:344–346

    Article  CAS  Google Scholar 

  8. van Staa TP, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787

    Article  PubMed  Google Scholar 

  9. Kanis JA, Johansson H, Oden A, Johnell O, de Laet C, Melton LJ III, Tenenhouse A, Reeve J, Silman AJ, Pols HA, Eisman JA, McCloskey EV, Mellstrom D (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899

    Article  PubMed  Google Scholar 

  10. Compston J (2010) Management of glucocorticoid-induced osteoporosis. Nat Rev Rheumatol 6:82–88

    Article  CAS  PubMed  Google Scholar 

  11. Cawthon PM (2011) Gender differences in osteoporosis and fractures. Clin Orthop Relat Res 469:1900–1905

    Article  PubMed Central  PubMed  Google Scholar 

  12. Overman RA, Toliver JC, Yeh JY, Gourlay ML, Deal CL (2014) U.S. Adults meeting 2010 American College of Rheumatology criteria for treatment and prevention of glucocorticoid-induced osteoporosis. Arthr Care Res (Hoboken) 66:1644–1652

    Article  Google Scholar 

  13. Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M (2007) Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 11:iii,iv, ix-xi, 1-231

  14. Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386

    Article  CAS  PubMed  Google Scholar 

  15. Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, Curtis JR, Furst DE, McMahon M, Patkar NM, Volkmann E, Saag KG (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthr Care Res (Hoboken) 62:1515–1526

    Article  Google Scholar 

  16. Compston J, Bowring C, Cooper A, Cooper C, Davies C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P (2013) Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75:392–396

    Article  CAS  PubMed  Google Scholar 

  17. Duru N, van der Goes MC, Jacobs JW, Andrews T, Boers M, Buttgereit F, Caeyers N, Cutolo M, Halliday S, Da Silva JA, Kirwan JR, Ray D, Rovensky J, Severijns G, Westhovens R, Bijlsma JW (2013) EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 72:1905–1913

    Article  CAS  PubMed  Google Scholar 

  18. Homik JE, Cranney A, Shea B, Tugwell P, Wells G, Adachi R, Suarez-Almazor M (2000) Bisphosphonates for steroid induced osteoporosis. Cochrane Database of Systematic Reviews :CD001347

  19. Adachi JD, Saag KG, Delmas PD, Liberman UA, Emkey RD, Seeman E, Lane NE, Kaufman JM, Poubelle PE, Hawkins F, Correa-Rotter R, Menkes CJ, Rodriguez-Portales JA, Schnitzer TJ, Block JA, Wing J, McIlwain HH, Westhovens R, Brown J, Melo-Gomes JA, Gruber BL, Yanover MJ, Leite MO, Siminoski KG, Nevitt MC, Sharp JT, Malice MP, Dumortier T, Czachur M, Carofano W, Daifotis A (2001) Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum 44:202–211

    Article  CAS  PubMed  Google Scholar 

  20. Wallach S, Cohen S, Reid DM, Hughes RA, Hosking DJ, Laan RF, Doherty SM, Maricic M, Rosen C, Brown J, Barton I, Chines AA (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67:277–285

    Article  CAS  PubMed  Google Scholar 

  21. National Quality Forum (2012) 0614 Steroid use—osteoporosis screening. http://www.qualityforum.org/QPS/0614 Accessed 01 September 2014

  22. National Quality Forum (2012) 0633 Osteopenia and chronic steroid use—treatment to prevent osteoporosis. http://www.qualityforum.org/QPS/0633 Accessed 01 September 2014

  23. Majumdar SR, Lix LM, Morin SN, Yogendran M, Metge CJ, Leslie WD (2013) The disconnect between better quality of glucocorticoid-induced osteoporosis preventive care and better outcomes: a population-based cohort study. J Rheumatol 40:1736–1741

    Article  CAS  PubMed  Google Scholar 

  24. Thomas T, Horlait S, Ringe JD, Abelson A, Gold DT, Atlan P, Lange JL (2013) Oral bisphosphonates reduce the risk of clinical fractures in glucocorticoid-induced osteoporosis in clinical practice. Osteoporos Int 24:263–269

    Article  CAS  PubMed  Google Scholar 

  25. Saag KG, Curtis J, Warriner A (2013) Challenges in defining quality of care for glucocorticoid-induced osteoporosis: defending good against perfect. J Rheumatol 40:1640–1642

    Article  PubMed  Google Scholar 

  26. Hansen L, Chang S (2013) White paper: health research data for the real world: the MarketScan(R) databases

  27. In: ClinicalTrials.gov. Amgen (2014) Study to show treatment with d’mab as good as treatment with risedronate in subjects start to take or taking GCs (GIOP). http://clinicaltrials.gov/show/NCT01575873 NLM Identifier: NCT01575873. Accessed 01 September 2014

  28. Hakala M, Kroger H, Valleala H, Hienonen-Kempas T, Lehtonen-Veromaa M, Heikkinen J, Tuomiranta T, Hannonen P, Paimela L, ONCE trial group (2012) Once-monthly oral ibandronate provides significant improvement in bone mineral density in postmenopausal women treated with glucocorticoids for inflammatory rheumatic diseases: a 12-month, randomized, double-blind, placebo-controlled trial. Scand J Rheumatol 41:260–266

    Article  CAS  PubMed  Google Scholar 

  29. Ray WA (2003) Evaluating medication effects outside of clinical trials: new-user designs. Am J Epidemiol 158:915–920

    Article  PubMed  Google Scholar 

  30. Webb R, Singer M (2005) Oxford handbook of critical care. Oxford University Press, New York

    Google Scholar 

  31. Brunelli SM, Gagne JJ, Huybrechts KF, Wang SV, Patrick AR, Rothman KJ, Seeger JD (2013) Estimation using all available covariate information versus a fixed look-back window for dichotomous covariates. Pharmacoepidemiol Drug Saf 22:542–550

    Article  PubMed  Google Scholar 

  32. Curtis JR, Taylor AJ, Matthews RS, Ray MN, Becker DJ, Gary LC, Kilgore ML, Morrisey MA, Saag KG, Warriner A, Delzell E (2009) “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures? Osteoporos Int 20:1969–1972

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  PubMed  Google Scholar 

  34. Office of the Surgeon General (US) (2004) Bone health and osteoporosis: a report of the surgeon general. Office of the Surgeon General (US), Rockville

    Google Scholar 

  35. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. doi:10.1007/s00198-014-2794-2

    PubMed Central  PubMed  Google Scholar 

  36. Schneeweiss S, Wang PS, Avorn J, Glynn RJ (2003) Improved comorbidity adjustment for predicting mortality in Medicare populations. Health Serv Res 38:1103–1120

    Article  PubMed Central  PubMed  Google Scholar 

  37. Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K, Solomon DH (2010) Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 12:R154

    Article  PubMed Central  PubMed  Google Scholar 

  38. Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, Saag K (2011) Which fractures are most attributable to osteoporosis? J Clin Epidemiol 64:46–53

    Article  PubMed  Google Scholar 

  39. Brookhart MA, Wyss R, Layton JB, Sturmer T (2013) Propensity score methods for confounding control in nonexperimental research. Circ Cardiovasc Qual Outcomes 6:604–611

    Article  PubMed Central  PubMed  Google Scholar 

  40. Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127:757–763

    Article  CAS  PubMed  Google Scholar 

  41. Duyvendak M, Naunton M, Atthobari J, van den Berg PB, Brouwers JR (2007) Corticosteroid-induced osteoporosis prevention: longitudinal practice patterns in The Netherlands 2001-2005. Osteoporos Int 18:1429–1433

    Article  CAS  PubMed  Google Scholar 

  42. Saag KG, Gehlbach SH, Curtis JR, Youket TE, Worley K, Lange JL (2006) Trends in prevention of glucocorticoid-induced osteoporosis. J Rheumatol 33:1651–1657

    PubMed  Google Scholar 

  43. Silverman S, Curtis J, Saag K, Flahive J, Adachi J, Anderson F, Chapurlat R, Cooper C, Diez-Perez A, Greenspan S, Hooven F, Le Croix A, March L, Netelenbos JC, Nieves J, Pfeilschifter J, Rossini M, Roux C, Siris E, Watts N, Compston J (2014) International management of bone health in glucocorticoid-exposed individuals in the observational GLOW study. Osteoporos Int. doi:10.1007/s00198-014-2883-2

    Google Scholar 

  44. Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45:703–714

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The database infrastructure used for this project was funded by the Department of Epidemiology, UNC Gillings School of Global Public Health; the Cecil G. Sheps Center for Health Services Research, UNC; the CER Strategic Initiative of UNC’s Clinical Translational Science Award (1 ULI RR025747); and the UNC School of Medicine.

Conflicts of interest

Robert A. Overman, Margret L. Gourlay, Chad L. Deal, and J. Bradley Layton declare that they have no conflicts of interest. Joel F. Farley has received prior consulting support from Daiichi-Sankyo Pharmaceuticals for unrelated research. M. Alan Brookhart has received research support Amgen and has sat on advisory boards for Amgen, Merck, and Pfizer (honoraria received by institution). He has received consulting fees from RxAnte, Inc. and World Health Information Science Consultants, LLC.

Author information

Authors and Affiliations

  1. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7573, Chapel Hill, NC, 27599-7573, USA

    R. A. Overman & J. F. Farley

  2. Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M. L. Gourlay

  3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M. A. Brookhart & J. B. Layton

  4. Department of Rheumatology, Orthopedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    R. A. Overman & C. L. Deal

Authors
  1. R. A. Overman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. L. Gourlay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. L. Deal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. F. Farley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. A. Brookhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. B. Layton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. A. Overman.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

(PDF 14 kb)

Supplementary Table 2

(PDF 8 kb)

Supplementary Table 3

(PDF 91 kb)

Supplementary Figure 1

(PDF 13 kb)

Supplementary Figure 2

(PDF 13 kb)

Supplementary Figure 3

(PDF 13 kb)

Supplementary Figure 4

(PDF 13 kb)

Supplementary Figure 5

(PDF 11 kb)

Supplementary Figure 6

(PDF 11 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Overman, R.A., Gourlay, M.L., Deal, C.L. et al. Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis. Osteoporos Int 26, 1515–1524 (2015). https://doi.org/10.1007/s00198-014-3022-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-014-3022-9

Keywords

Search

Navigation