Early initiation of anti-osteoporosis medication reduces fracture events

For patients on glucocorticoid (GC) therapy, a delay in anti-osteoporosis treatment initiation may lead to increased fracture events, while early treatment helps to prevent them, a study has found.

The study used the nationwide health insurance claims database of Japan (NDBJ) and identified patients aged ≥50 years who were prescribed GC (≥5 mg/day prednisolone or equivalent) for ≥90 days. These patients were followed for anti-osteoporosis medication (AOM) use and the incidence of hip and vertebral fracture events for the subsequent 1,080 days.

Researchers used Cox proportional hazards regression to evaluate the delay in AOM initiation in relation to the hip and vertebral fracture risk. Delay in AOM initiation was defined as the number of days without AOMs following initiation of GC therapy.

The analysis included 92,143 women and 94,772 men, among whom only 39.3 percent and 28.5 percent, respectively, received AOMs within 90 days from GC therapy initiation. Among those who were not initiated on AOM immediately after GC therapy, about 15 percent of hip fractures and 30 percent of vertebral fractures occurred before AOM initiation. The risk estimates of both fracture outcomes were significantly increased commensurate with the duration of delay in AOM initiation (p<0.001 for trend).

In an analysis that excluded patients who had fractures prior to AOM initiation, the magnitude of the risk estimates was significantly attenuated, and the hazard ratio trends for hip fracture became insignificant.