Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis

R. A. Overman, M. L. Gourlay, C. L. Deal, J. F. Farley, M. A. Brookhart, J. B. Layton

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Summary: Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.

Introduction: The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.

Methods: A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.

Results: Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.

Conclusions: AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.

Original languageEnglish (US)
Pages (from-to)1515-1524
Number of pages10
JournalOsteoporosis International
Issue number5
StatePublished - May 1 2015

Bibliographical note

Publisher Copyright:
© 2015, International Osteoporosis Foundation and National Osteoporosis Foundation.


  • Anti-osteoporosis medication
  • Glucocorticoid-induced osteoporosis
  • Osteoporotic fracture
  • Quality measures


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