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PMID- 28697254
OWN - NLM
STAT- In-Process
DA  - 20170711
LR  - 20170711
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 2
DP  - 2017 Jul 11
TI  - Association Between Alendronate Use and Hip Fracture Risk in Older Patients Using
      Oral Prednisolone.
PG  - 146-155
LID - 10.1001/jama.2017.8040 [doi]
AB  - Importance: Oral glucocorticoid treatment increases fracture risk, and evidence
      is lacking regarding the efficacy of alendronate to protect against hip fracture 
      in older patients using glucocorticoids. Objective: To investigate whether
      alendronate treatment in older patients using oral prednisolone is associated
      with decreased hip fracture risk and adverse effects. Design, Setting, and
      Participants: Retrospective cohort study using a national database (N = 433195)
      of patients aged 65 years or older undergoing a health evaluation (baseline) at
      Swedish health care facilities; 1802 patients who were prescribed alendronate
      after at least 3 months of oral prednisolone treatment (>/=5 mg/d) were
      identified. Propensity score matching was used to select 1802 patients without
      alendronate use from 6076 patients taking prednisolone with the same dose and
      treatment time criteria. Follow-up occurred between January 2008 and December
      2014. Exposures: Alendronate vs no alendronate use; no patients had previously
      taken alendronate at the time of prednisolone initiation. Main Outcomes and
      Measures: The primary outcome was incident hip fracture. Results: Of the 3604
      included patients, the mean age was 79.9 (SD, 7.5) years, and 2524 (70%) were
      women. After a median follow-up of 1.32 years (interquartile range, 0.57-2.34
      years), there were 27 hip fractures in the alendronate group and 73 in the
      no-alendronate group, corresponding to incidence rates of 9.5 (95% CI, 6.5-13.9) 
      and 27.2 (95% CI, 21.6-34.2) fractures per 1000 person-years, with an absolute
      rate difference of -17.6 (95% CI, -24.8 to -10.4). The use of alendronate was
      associated with a lower risk of hip fracture in a multivariable-adjusted Cox
      model (hazard ratio, 0.35; 95% CI, 0.22-0.54). Alendronate treatment was not
      associated with increased risk of mild upper gastrointestinal tract symptoms
      (alendronate vs no alendronate, 15.6 [95% CI, 11.6-21.0] vs 12.9 [95% CI,
      9.3-18.0] per 1000 person-years; P = .40) or peptic ulcers (10.9 [95% CI,
      7.7-15.5] vs 11.4 [95% CI, 8.0-16.2] per 1000 person-years; P = .86). There were 
      no cases of incident drug-induced osteonecrosis and only 1 case of femoral shaft 
      fracture in each group. Conclusions and Relevance: Among older patients using
      medium to high doses of prednisolone, alendronate treatment was associated with a
      significantly lower risk of hip fracture over a median of 1.32 years. Although
      the findings are limited by the observational study design and the small number
      of events, these results support the use of alendronate in this patient group.
FAU - Axelsson, Kristian F
AU  - Axelsson KF
AD  - Department of Orthopaedic Surgery, Skaraborg Hospital, Skovde, Sweden2Geriatric
      Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of
      Medicine, University of Gothenburg, Gothenburg, Sweden.
FAU - Nilsson, Anna G
AU  - Nilsson AG
AD  - Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition,
      Institute of Medicine, University of Gothenburg, Gothenburg, Sweden3Department of
      Endocrinology, Internal Medicine, Sahlgrenska University Hospital, Gothenburg,
      Sweden.
FAU - Wedel, Hans
AU  - Wedel H
AD  - Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
      Sweden.
FAU - Lundh, Dan
AU  - Lundh D
AD  - School of Bioscience, University of Skovde, Skovde, Sweden.
FAU - Lorentzon, Mattias
AU  - Lorentzon M
AD  - Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition,
      Institute of Medicine, University of Gothenburg, Gothenburg, Sweden6Geriatric
      Medicine, Sahlgrenska University Hospital, Molndal, Sweden.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
EDAT- 2017/07/12 06:00
MHDA- 2017/07/12 06:00
CRDT- 2017/07/12 06:00
AID - 2643309 [pii]
AID - 10.1001/jama.2017.8040 [doi]
PST - ppublish
SO  - JAMA. 2017 Jul 11;318(2):146-155. doi: 10.1001/jama.2017.8040.