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. 2021 Jun 8;10(12):2541.
doi: 10.3390/jcm10122541.

Timing of Bisphosphonate (Alendronate) Initiation after Surgery for Fragility Fracture: A Population-Based Cohort Study

Meng-Huang Wu  1   2 , Yu-Sheng Lin  3   4 , Christopher Wu  5 , Ching-Yu Lee  1   2 , Yi-Chia Chen  6 , Tsung-Jen Huang  1   2 , Jur-Shan Cheng  7   8   9
Affiliations

Timing of Bisphosphonate (Alendronate) Initiation after Surgery for Fragility Fracture: A Population-Based Cohort Study

Meng-Huang Wu et al. J Clin Med. .

Abstract

Bisphosphonates are used as first-line treatment for the prevention of fragility fracture (FF); they act by inhibiting osteoclast-mediated bone resorption. The timing of their administration after FF surgery is controversial; thus, we compared the incidence of second FF, surgery for second FF, and adverse events associated with early initiation of bisphosphonates (EIBP, within 3 months of FF surgery) and late initiation of bisphosphonates (LIBP, 3 months after FF surgery) in bisphosphonate-naïve patients. This retrospective population-based cohort study used data from Taiwan's Health and Welfare Data Science Center (2004-2012). A total of 298,377 patients received surgeries for FF between 2006 and 2010; of them, 1209 (937 EIBP and 272 LIBP) received first-time bisphosphonates (oral alendronate, 70 mg, once a week). The incidence of second FF (subdistribution hazard ratio (SHR) = 0.509; 95% confidence interval (CI): 0.352-0.735), second FF surgery (SHR = 0.452; 95% CI: 0.268-0.763), and adverse events (SHR = 0.728; 95% CI: 0.594-0.893) was significantly lower in the EIBP group than in the LIBP group. Our findings indicate that bisphosphonates should be initiated within 3 months after surgery for FF.

Keywords: adverse events; fragility fracture; initiation timing; second fracture.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study protocol. BP: bisphosphonate (alendronate); MPR: medication possession ratio.
Figure 2
Figure 2
Risk factors and adjusted hazard ratio of fragility fractures stratified by bisphosphonate initiation time, sex, age, Charlson comorbidity index, and comorbidities, by using a proportional subdistribution hazards model. BP: bisphosphonate initiation; CCI: Charlson comorbidity index; CI: confidence interval.
Figure 3
Figure 3
Cumulative incidence of (A) second fragility fracture, (B) second fragility fracture surgery, and (C) revision surgery in patients with bisphosphonate initiation within 3 months after fragility fracture surgery versus more than 3 months after fragility fracture surgery.
Figure 4
Figure 4
Forest plot of (A) second fragility fracture, (B) second fragility fracture surgery, and (C) revision surgery in patients with bisphosphonate initiation within 3 months after fragility fracture surgery versus more than 3 months after fragility fracture surgery for different fragility fracture types and age groups. SHR, subdistribution hazard ratio; CI, confidence interval; Upper, upper limb; Lower, lower limb.
See this image and copyright information in PMC

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