Table 1.
Baseline Characteristics of new users of alendronate, risedronate, ibandronate, and denosumab
| Alendronate | Risedronate | Ibandronate | Denosumab | |
|---|---|---|---|---|
| N = 128,590 | N = 892 | N = 5855 | N = 16,469 | |
| Sex, n (%) | ||||
| Female | 101,119 (78.6) | 773 (86.7) | 5186 (88.6) | 14,659 (89.0) |
| Male | 27,471 (21.4) | 119 (13.3) | 669 (11.4) | 1810 (11.0) |
| Age, years median (IQR) | 70 (63–78) | 70 (63–77) | 70 (63–77) | 72 (65–80) |
| Age group, n (%) | ||||
| 50– < 55 | 7056 (5.5) | 51 (5.7) | 271 (4.6) | 569 (3.5) |
| 55– < 60 | 12,419 (9.7) | 90 (10.1) | 598 (10.2) | 1192 (7.2) |
| 60– < 65 | 17,402 (13.5) | 116 (13.0) | 816 (13.9) | 1885 (11.4) |
| 65– < 70 | 22,738 (17.7) | 173 (19.4) | 1075 (18.4) | 2843 (17.3) |
| 70– < 75 | 22,742 (17.7) | 167 (18.7) | 1093 (18.7) | 2984 (18.1) |
| 75 + | 46,233 (36.0) | 295 (33.1) | 2002 (34.2) | 6996 (42.5) |
| Year of treatment initiation, n (%) | ||||
| 2010 | 9514 (7.4) | 53 (5.9) | 668 (11.4) | 490 (3.0) |
| 2011 | 16,866 (13.1) | 209 (23.4) | 949 (16.2) | 2253 (13.7) |
| 2012 | 15,882 (12.4) | 113 (12.7) | 640 (10.9) | 2241 (13.6) |
| 2013 | 15,237 (11.8) | 76 (8.5) | 638 (10.9) | 2037 (12.4) |
| 2014 | 14,699 (11.4) | 115 (12.9) | 654 (11.2) | 2128 (12.9) |
| 2015 | 14,435 (11.2) | 43 (4.8) | 623 (10.6) | 2084 (12.7) |
| 2016 | 14,255 (11.1) | 76 (8.5) | 567 (9.7) | 1819 (11.0) |
| 2017 | 13,895 (10.8) | 96 (10.8) | 528 (9.0) | 1737 (10.5) |
| 2018 | 13,807 (10.7) | 111 (12.4) | 588 (10.0) | 1680 (10.2) |
| Region of residence, n (%) | ||||
| Capital | 31,725 (24.7) | 283 (31.7) | 1356 (23.2) | 4049 (24.6) |
| Zealand | 18,404 (14.3) | 90 (10.1) | 1144 (19.5) | 1962 (11.9) |
| Southern Denmark | 30,335 (23.6) | 182 (20.4) | 1038 (17.7) | 2865 (17.4) |
| Central Jutland | 31,786 (24.7) | 222 (24.9) | 1532 (26.2) | 5152 (31.3) |
| Northern Jutland | 16,340 (12.7) | 115 (12.9) | 785 (13.4) | 2441 (14.8) |
| Annual household income, n (%) | ||||
| < 200,000 kr | 21,694 (16.9) | 150 (16.8) | 945 (16.1) | 2911 (17.7) |
| 200,000–300,000 kr | 36,927 (28.7) | 237 (26.6) | 1706 (29.1) | 5029 (30.5) |
| 300,000–400,000 kr | 22,596 (17.6) | 153 (17.2) | 1050 (17.9) | 2939 (17.8) |
| ≥ 400,000 kr | 47,252 (36.7) | 352 (39.5) | 2154 (36.8) | 5590 (33.9) |
| Missing | 121 (0.1) | ↑ | ↑ | ↑ |
| Educational level, n (%) | ||||
| Primary school | 53,004 (41.2) | 327 (36.7) | 2375 (40.6) | 6850 (41.6) |
| Secondary school | 49,131 (38.2) | 345 (38.7) | 2295 (39.2) | 6026 (36.6) |
| Higher | 23,114 (18.0) | 202 (22.6) | 1036 (17.7) | 3178 (19.3) |
| Missing | 3341 (2.6) | 18 (2.0) | 149 (2.5) | 415 (2.5) |
| Employment status, n (%) | ||||
| Director/chief executive | 10,177 (7.9) | 78 (8.7) | 410 (7.0) | 956 (5.8) |
| Employer/self-employed | 3366 (2.6) | 22 (2.5) | 150 (2.6) | 342 (2.1) |
| Skilled worker | 8873 (6.9) | 47 (5.3) | 339 (5.8) | 671 (4.1) |
| Unskilled worker | 2013 (1.6) | 12 (1.3) | 74 (1.3) | 134 (0.8) |
| Early retirement/pension | 97,371 (75.7) | 693 (77.7) | 4559 (77.9) | 13,727 (83.4) |
| Unemployed, benefits/public support | 2988 (2.3) | 12 (1.3) | 123 (2.1) | 217 (1.3) |
| Other | 3802 (3.0) | 28 (3.1) | 200 (3.4) | 422 (2.6) |
| Missing | ↑ | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Comorbidities | ||||
| Charlson comorbidity index (CCI), n (%) | ||||
| Low | 78,363 (60.9) | 545 (61.1) | 3736 (63.8) | 9584 (58.2) |
| Medium | 39,427 (30.7) | 274 (30.7) | 1692 (28.9) | 5215 (31.7) |
| High | 10,800 (8.4) | 73 (8.2) | 427 (7.3) | 1670 (10.1) |
| Individual comorbidities, n (%) | ||||
| Chronic obstructive pulmonary disease | 15,719 (12.2) | 98 (11.0) | 722 (12.3) | 2241 (13.6) |
| Chronic renal impairment | 1679 (1.3) | 13 (1.5) | 31 (0.5) | 478 (2.9) |
| Diabetes | 11,836 (9.2) | 67 (7.5) | 399 (6.8) | 1327 (8.1) |
| Dementia | 2395 (1.9) | 8 (0.9) | 83 (1.4) | 396 (2.4) |
| Any malignancy | 22,326 (17.4) | 145 (16.3) | 954 (16.3) | 3043 (18.5) |
| Breast cancer | 7951 (6.2) | 48 (5.4) | 399 (6.8) | 1063 (6.5) |
| Prostate cancer | 1778 (1.4) | < 5 | 33 (0.6) | 185 (1.1) |
| Intestine cancer | 2708 (2.1) | 17 (1.9) | 117 (2.0) | 365 (2.2) |
| Lung cancer | 1583 (1.2) | 9 (1.0) | 66 (1.1) | 200 (1.2) |
| Pancreatic cancers | 118 (0.1) | 0 (0.0) | < 5 | 25 (0.2) |
| Cancer of the urinary tract, including kidneys | 877 (0.7) | 6 (0.7) | 26 (0.4) | 127 (0.8) |
| Hematological malignancy | 1808 (1.4) | 20 (2.2) | 62 (1.1) | 228 (1.4) |
| Metastasis and non-specified cancer in lymph nodes | 1911 (1.5) | 9 (1.0) | 86 (1.5) | 266 (1.6) |
| Other malignancy | 7722 (6.0) | 56 (6.3) | 330 (5.6) | 1188 (7.2) |
| Osteoporosis-related characteristics | ||||
| Hospital diagnosis of osteoporosis, n (%) | 48,556 (37.8) | 484 (54.3) | 2520 (43.0) | 11,931 (72.4) |
| Months from hospital diagnosis of osteoporosis to index date among patients with hospital diagnosis of osteoporosis, median (IQR) | 2 (0–7) | 19 (5–56) | 22 (5–61) | 31 (7–79) |
| History of hip fracture, n (%) | 11,814 (9.2) | 50 (5.6) | 382 (6.5) | 1740 (10.6) |
| History of vertebral fracture, n (%) | 4136 (3.2) | 22 (2.5) | 186 (3.2) | 880 (5.3) |
| History of forearm fracture, n (%) | 18,906 (14.7) | 152 (17.0) | 917 (15.7) | 3143 (19.1) |
| History of humerus fracture, n (%) | 7880 (6.1) | 52 (5.8) | 393 (6.7) | 1362 (8.3) |
| Months from diagnosis of last major osteoporotic fracture to index date among patients with hospital diagnosis of hip, vertebral, forearm, or humerus fracture, median (IQR) | 53 (7–133) | 67 (22–150) | 71 (22–145) | 80 (28–149) |
| DXA scan procedure, n (%) | 100,178 (77.9) | 777 (87.1) | 5143 (87.8) | 15,215 (92.4) |
|
Months from the last DXA procedure to the index date among patients with DXA procedure, median (IQR) |
2 (0–34) | 28 (5–66) | 25 (4–68) | 50 (13–90) |
| Prior osteoporosis treatment (OT)x, n | ||||
| All OTx | 5980 (4.7) | 754 (84.5) | 4727 (80.7) | 14,128 (85.8) |
| Raloxifene | 848 (0.7) | 16 (1.8) | 121 (2.1) | 727 (4.4) |
| Teriparatide | 1107 (0.9) | 21 (2.4) | 87 (1.5) | 1060 (6.4) |
| Parathyroid hormone | 108 (0.1) | 6 (0.7) | 9 (0.2) | 159 (1.0) |
| Etidronate | 2646 (2.1) | 66 (7.4) | 304 (5.2) | 1467 (8.9) |
| Alendronate | 0 (0.0) | 741 (83.1) | 4602 (78.6) | 13,217 (80.3) |
| Ibandronate | 851 (0.7) | 45 (5.0) | < 5 | 1854 (11.3) |
| Risedronate | 337 (0.3) | 0 (0.0) | 91 (1.6) | 390 (2.4) |
| Zoledronic acid | 6 (0.0) | < 5 | < 5 | 40 (0.2) |
| Strontium ranelate | 558 (0.4) | 24 (2.7) | 201 (3.4) | 1037 (6.3) |
| Denosumab | 160 (0.1) | 30 (3.4) | 85 (1.5) | 0 (0.0) |
| Months from the last dispensing of prior OTx to the index date among patients with prior OTx use, n (%) | 106 (27–151) | 14 (4–53) | 16 (4–55) | 51 (14–101) |
| Concomitant medication, n (%) | ||||
| Oral corticosteroids | 32,974 (25.6) | 191 (21.4) | 1208 (20.6) | 2719 (16.5) |
| Anticoagulants | 10,999 (8.6) | 54 (6.1) | 377 (6.4) | 1468 (8.9) |
| Antidiabetics | 9172 (7.1) | 54 (6.1) | 295 (5.0) | 938 (5.7) |
| Antithrombotics | 33,477 (26.0) | 209 (23.4) | 1434 (24.5) | 4501 (27.3) |
| Hormone replacement theory | 19,178 (14.9) | 178 (20.0) | 1149 (19.6) | 3273 (19.9) |
| Hormone deprivation theory | 159 (0.1) | 0 (0.0) | 9 (0.2) | 16 (0.1) |
| Anxiolytics and sedatives | 26,790 (20.8) | 191 (21.4) | 1420 (24.3) | 4187 (25.4) |
| Antipsychotics | 4617 (3.6) | 25 (2.8) | 187 (3.2) | 609 (3.7) |
| Antidepressants | 22,788 (17.7) | 125 (14.0) | 1091 (18.6) | 3433 (20.8) |
| Statins | 38,591 (30.0) | 232 (26.0) | 1603 (27.4) | 4827 (29.3) |
| Non-steroid anti-inflammatory drugs | 40,821 (31.7) | 243 (27.2) | 1725 (29.5) | 4131 (25.1) |
| Antihypersentive drugs | 70,983 (55.2) | 451 (50.6) | 3064 (52.3) | 9222 (56.0) |
| Drugs for the treatment of chronic obstructive pulmonary disease | 37,226 (28.9) | 278 (31.2) | 1864 (31.8) | 5080 (30.8) |
| Opioids | 46,855 (36.4) | 247 (27.7) | 1950 (33.3) | 6171 (37.5) |
| Anti-thyroid drugs | 2425 (1.9) | 15 (1.7) | 133 (2.3) | 345 (2.1) |
| Healthcare utilization in the year before the index date, n (%) | ||||
| Number of hospitalizations | ||||
| 0 | 83,905 (65.3) | 678 (76.0) | 4453 (76.1) | 11,194 (68.0) |
| 1 | 27,200 (21.2) | 154 (17.3) | 942 (16.1) | 2920 (17.7) |
| > 1 | 17,485 (13.6) | 60 (6.7) | 460 (7.9) | 2355 (14.3) |
| Number of outpatient visits | ||||
| 0 | 36,006 (28.0) | 249 (27.9) | 2100 (35.9) | 3190 (19.4) |
| 1 | 25,674 (20.0) | 184 (20.6) | 1101 (18.8) | 3217 (19.5) |
| > 1 | 66,910 (52.0) | 459 (51.5) | 2654 (45.3) | 10,062 (61.1) |
| Number of emergency room visits | ||||
| 0 | 98,700 (76.8) | 737 (82.6) | 4925 (84.1) | 13,140 (79.8) |
| 1 | 22,629 (17.6) | 123 (13.8) | 746 (12.7) | 2460 (14.9) |
| > 1 | 7261 (5.6) | 32 (3.6) | 184 (3.1) | 869 (5.3) |