Table 3.
Time-Varying Factors Associated With Prolonged Discontinuation of Alendronate
|
N = 20,455 |
|||
|---|---|---|---|
| Hazard period n (%) |
Control periods 1 and 2 n (%) |
Adjusted OR (Wald 95% CI) |
|
| Factors associated with bone health | |||
| Case qualifying fragility fracture | 441 (2.2) | 400 (1.0) | 1.2 (1.0, 1.4) |
| Osteopenia diagnosis | 1499 (7.3) | 1794 (4.4) | 1.8 (1.7, 2.0) |
| Osteoporosis diagnosis | 5510 (26.9) | 7820 (19.1) | 1.4 (1.3, 1.5) |
| Fall | 744 (3.6) | 986 (2.5) | 1.0 (0.9, 1.1) |
| DXA scan | 2884 (14.1) | 3219 (7.9) | 1.7 (1.6, 1.7) |
| Bone turnover markers | 3 (0.0) | 1 (0.0) | 6.6 (0.7, 64.2) |
| At least 1 visit with an osteoporosis specialist (rheumatologist or endocrinologist) | 1328 (6.5) | 2343 (5.7) | 1.2 (1.0, 1.3) |
| Factors associated with overall health status | |||
| No. of unique days with at least 1 physician visit | 6512 (31.8) | 15,079 (36.9) | ref |
| 0–1 | |||
| 2–4 | 6605 (32.3) | 13,694 (33.5) | 1.0 (1.0, 1.1) |
| 5 or more | 7338 (35.9) | 12,137 (29.7) | 1.3 (1.2, 1.3) |
| Charlson comorbidity index | 15,726 (76.9) | 32,382 (79.2) | ref |
| 0 | |||
| 1 to 2 | 3507 (17.1) | 6690 (16.4) | 1.0 (0.9, 1.1) |
| 3+ | 1222 (6.0) | 1838 (4.5) | 1.1 (1.0, 1.3) |
| At least 1 ER visit | 3694 (18.1) | 4706 (11.5) | 1.2 (1.1, 1.2) |
| At least 1 day hospitalized as inpatient | 2538 (12.4) | 2358 (5.8) | 1.5 (1.3, 1.6) |
| Hospitalized stroke, MI, CHD, CVD event | 97 (0.5) | 130 (0.3) | 0.7 (0.5, 1.0) |
| Any skilled nursing facility care | 1163 (5.7) | 791 (2.0) | 1.9 (1.7, 2.2) |
| Alzheimer’s or other dementia | 2176 (10.6) | 2858 (7.0) | 2.0 (1.8, 2.3) |
| Depression or anxiety | 2251 (11.0) | 3309 (8.1) | 1.1 (1.0, 1.2) |
| Medications | |||
| Alpha blocker | 1350 (6.6) | 2456 (6.1) | 1.6 (1.3, 1.9) |
| Anticholinergic antihistamine | 284 (1.4) | 538 (1.3) | 0.9 (0.8, 1.1) |
| Antipsychotic | 189 (0.9) | 355 (0.9) | 1.4 (0.8, 2.4) |
| Barbiturate | 34 (0.2) | 38 (0.1) | 23.6 (3.1, 181.8) |
| Benzodiazepine | 1168 (5.7) | 1345 (3.3) | 3.1 (2.7, 3.6) |
| Beta blocker | 7871 (38.5) | 15,238 (37.3) | 1.3 (1.2, 1.4) |
| Muscle relaxant | 712 (3.5) | 1379 (3.4) | 0.9 (0.8, 1.1) |
| Nonbenzodiazepine, benzodiazepine agonist | 902 (4.4) | 1801 (4.4) | 0.9 (0.8, 1.1) |
| Opioid | 4852 (23.7) | 8823 (21.6) | 1.1 (1.0, 1.1) |
| Oral glucocorticoids | 1597 (7.8) | 2949 (7.3) | 1.2 (1.1, 1.3) |
| Proton pump inhibitor | 4900 (24.0) | 8684 (21.3) | 1.8 (1.6, 1.9) |
| Selective serotonin reuptake inhibitor | 3560 (17.4) | 6613 (16.2) | 1.5 (1.3, 1.7) |
| Tricyclic antidepressant | 496 (2.4) | 1055 (2.6) | 0.7 (0.6, 1.0) |
| Vasodilator | 992 (4.9) | 1766 (4.3) | 1.5 (1.3, 1.9) |
OR = odds ratio; CI = confidence interval; DXA = dual-energy X-ray absorptiometry; ER = emergency room; MI = myocardial infarction; CHD = chronic heart disease; CVD = cardiovascular disease.
Associations significant at p value <0.01 are in bold.