Association of bisphosphonate therapy with incident lower extremity fractures in persons with spinal cord injuries/disorders

Archives of Physical Medicine and Rehabilitation Jan 24, 2020

Carbone LD, Gonzalez B, Miskevics S, et al. – Researchers performed a propensity-matched case-control study to determine the association between prescriptions for bisphosphonates, calcium/vitamin D supplements, and receipt of dual-energy x-ray absorptiometry (DXA) screening, and incident fracture risk in men and women with a spinal cord injury/disorder (SCI/D). They identified 7,989 men and 849 women with an SCI/D included in VA administrative databases between October 1, 2005, and October 1, 2015. Cases included 267 men and 59 women with a bisphosphonate prescription propensity matched with up to 4 controls. Overall, the researchers did not identify any significant link between prescriptions for bisphosphonates and incident lower extremity fractures in men or women. In men, similar null associations were observed among those bisphosphonate therapy adherents, concomitant users of vitamin D/calcium and a bisphosphonate, those who had > 1 fracture on different dates during the study period, and in those who underwent DXA testing prior to the date of the bisphosphonate prescription and incident fracture. The researchers concluded that in men with a traumatic SCI and women with a traumatic SCI or disorder, bisphosphonate therapies for osteoporosis do not significantly affect fracture risk. Furthermore, sufficiently powered randomized clinical trials are warranted to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population.

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