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Comparative Study
. 2007 Jan;18(1):25-34.
doi: 10.1007/s00198-006-0274-z. Epub 2006 Nov 15.

Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: the risedronate and alendronate (REAL) cohort study

S L Silverman  1 , N B Watts, P D Delmas, J L Lange, R Lindsay
Affiliations
Comparative Study

Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: the risedronate and alendronate (REAL) cohort study

S L Silverman et al. Osteoporos Int. 2007 Jan.

Abstract

Introduction: Randomized clinical trials have shown that risedronate and alendronate reduce fractures among women with osteoporosis. The aim of this observational study was to observe, in clinical practice, the incidence of hip and nonvertebral fractures among women in the year following initiation of once-a-week dosing of either risedronate or alendronate.

Methods: Using records of health service utilization from July 2002 through September 2004, we created two cohorts: women (ages 65 and over) receiving risedronate (n = 12,215) or alendronate (n = 21,615). Cox proportional hazard modeling was used to compare the annual incidence of nonvertebral fractures and of hip fractures between cohorts, adjusting for potential differences in risk factors for fractures.

Results: There were 507 nonvertebral fractures and 109 hip fractures. Through one year of therapy, the incidence of nonvertebral fractures in the risedronate cohort (2.0%) was 18% lower (95% CI 2% - 32%) than in the alendronate cohort (2.3%). The incidence of hip fractures in the risedronate cohort (0.4%) was 43% lower (95% CI 13% - 63%) than in the alendronate cohort (0.6%). These results were consistent across a number of sensitivity analyses.

Conclusion: Patients receiving risedronate have lower rates of hip and nonvertebral fractures during their first year of therapy than patients receiving alendronate.

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Figures

Fig. 1
Fig. 1
Identification of the study population
Fig. 2
Fig. 2
Percent of patients with a clinical diagnosis of fracture before initiation of bisphosphonate therapy. 1ICD-9 codes 808.x, 810.x, 812.x, 813.x, 820.x, 821.x, 823.x, 733.10, -.12, -.14, -.19; 2ICD-9 codes 820.x, 733.14; 3ICD-9 codes 805.x, 806.x, 733.13; 4Subset (81%) of study population with available 12 month history. *Statistical difference (p<0.05) between cohorts
Fig. 3
Fig. 3
Cumulative incidence of nonvertebral fractures in patients treated with alendronate or risedronate for up to 1 year
Fig. 4
Fig. 4
Cumulative incidence of hip fractures in patients treated with alendronate or risedronate for up to 1 year
Fig. 5
Fig. 5
Sensitivity analysis: Rate ratio for fracture in the first year of therapy between patients on risedronate and patients on alendronate; results of the primary analysis and 4 other methods of analyses
See this image and copyright information in PMC

Comment in

References

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