Table 2.
Crude and Adjusted* Fracture Hazard Ratios† Among the Nonadherent (MPR < 50%) Compared With the Adherent (MPR ≥ 80%) Among All Persons and Those With Osteoporosis (OP), by Age and Fracture Type
| Fracture type‡ |
45–64
|
65–78
|
>78
|
||||||
| Events | Crude | Adjusted | Events | Crude | Adjusted | Events | Crude | Adjusted | |
| Hip | |||||||||
| All | 158 | 1.26 (0.87–1.82) | 1.11 (0.76–1.62) | 483 | 1.59 (1.28–1.98) | 1.41 (1.13–1.76) | 86 | 0.95 (0.58–1.55) | 0.87 (0.53–1.43) |
| Persons w/OP | 110 | 1.21 (0.78–1.90) | 1.08 (0.68–1.71) | 294 | 1.96 (1.48–2.60) | 1.74 (1.30–2.31) | 48 | 1.00 (0.53–1.91) | 0.88 (0.46–1.69) |
| Wrist/forearm | |||||||||
| All | 803 | 1.22 (1.03–1.43) | 1.21 (1.03–1.43) | 480 | 1.03 (0.83–1.26) | 0.97 (0.79–1.20) | 44 | 2.23 (0.98–5.06) | 2.21 (0.97–5.0) |
| Persons w/OP | 426 | 1.23 (0.98–1.55) | 1.22 (0.97–1.53) | 301 | 1.01 (0.77–1.31) | 0.93 (0.68–1.29) | 21 | 2.59 (0.81–8.28) | 2.93 (0.91–10.91) |
| Clinical vertebral | |||||||||
| All | 264 | 1.33 (1.00–1.77) | 1.28 (0.96–1.71) | 441 | 1.66 (1.31–2.10) | 1.48 (1.16–1.89) | 44 | 1.53 (0.66–3.54) | 1.39 (0.60–3.23) |
| Persons w/OP | 171 | 1.79 (1.26–2.53) | 1.70 (1.19–2.42) | 309 | 1.94 (1.46–2.57) | 1.70 (1.27–2.27) | 26 | 1.68 (0.58–4.89) | 1.72 (0.58–5.09) |
| Nonhip, nonvertebral | |||||||||
| All | 1360 | 1.17 (1.04–1.33) | 1.14 (1.01–1.30) | 981 | 1.18 (1.02–1.37) | 1.10 (0.95–1.28) | 99 | 1.38 (0.85–2.25) | 1.31 (0.80–2.15) |
| Persons w/OP | 736 | 1.20 (1.01–1.42) | 1.16 (0.97–1.38) | 604 | 1.15 (0.95–1.39) | 1.05 (0.90–1.27) | 52 | 1.38 (0.71–2.68) | 1.36 (0.70–2.64) |
| Nonvertebral | |||||||||
| All | 1452 | 1.16 (1.03–1.31) | 1.13 (1.00–1.28) | 1265 | 1.25 (1.10–1.43) | 1.14 (1.00–1.31) | 157 | 1.06 (0.74–1.53) | 0.98 (0.68–1.42) |
| Persons w/OP | 802 | 1.19 (1.01–1.40) | 1.14 (0.96–1.35) | 768 | 1.30 (1.10–1.54) | 1.19 (1.00–1.41) | 85 | 1.08 (0.67–1.77) | 0.99 (0.61–1.62) |
Each cell represents a separate result from a unique Cox proportional hazards model.
“Persons with OP” indicates that the person had a physician diagnosis of osteoporosis (ICD-9 733.0X) during the study period.
Number of nonvertebral fracture events is not the sum of hip fractures + nonhip, nonvertebral fractures because an individual who previously experienced a hip fracture in the 180 days preceding bisphosphonate use was excluded from being at-risk for another hip fracture but could experience a nonhip, nonvertebral fracture.
* Adjusted for age (except in >78-yr-old strata), sex, prior fracture, recent BMD test, recent screening test, comorbidities listed in Table 1, Charlson comorbidity index, number of outpatient visits, prior hospitalization, and use of glucocorticoids, systemic estrogens, and nonbisphosphonate osteoporosis medications.
† Estimates compare the rate of fracture among persons with MPR < 50% referent to those with MPR > 80%. Hazard ratios for persons with MPR 50–80% were generally intermediate between 1.0 and those presented.
‡ As coded from a physician Evaluation and Management (E/M) claim.