Association of Bone Density Monitoring in Routine Clinical Practice with Anti-Osteoporosis Medication Use and Incident Fractures: A Matched Cohort Study.
J Bone Miner Res. 2019 Jun 18;: Authors: Leslie WD, Morin SN, Martineau P, Bryanton M, Lix LM
Routine bone mineral density (BMD) monitoring of individuals during the initial 5 years of anti-osteoporosis treatment is controversial. Using a registry-based cohort from the Province of Manitoba, Canada, we compared anti-osteoporosis medication use and fracture outcomes in women with versus without BMD monitoring receiving anti-osteoporosis medication. We identified 4,559 women age 40 years and older receiving anti-osteoporosis therapy with serial BMD testing (monitoring) within 5 years (mean interval 3.2 years) and 4,559 propensity-score matched women without BMD monitoring. We assessed anti-osteoporosis medication use over 5 years from a population-based retail pharmacy database. Incident fractures to 10 years from health services data. During median 10 years observation, 1223 (13.4%) women developed major osteoporotic fracture including 382 (4.2%) with hip fractures. Monitored women had significantly better fracture-free survival for major osteoporotic fracture (P=0.040; 10 year cumulative risk 1.9% lower, 95% CI 0.3-3.6%) and hip fracture (P=0.001; 10 year cumulative risk 1.8% lower, 95% CI 0.7-2.8%) compared with women who were not monitored. Hazard ratios (HRs) were significantly lower in monitored vs not monitored women for major osteoporotic fracture (HR 0.89, 95% confidence interval 0.80-0.98) and hip fracture (0.74, 0.63-0.87). Days of medication use, medication persistence ratio and treatment switching over 5 years were greater in monitored vs not monitored women. At the end of 5 years, more women in the monitored group persisted on treatment and more switched treatment, with switching behavior associated with an observed interval reduction in BMD. In conclusion, our findings suggest a possible role for BMD monitoring after initiating anti-osteoporosis therapy in the routine clinical practice setting. This article is protected by copyright. All rights reserved. PMID: 31211871 [PubMed - as supplied by publisher]