Abstract
The objective of this propensity score-matched, observational cohort study was to determine the effectiveness of osteoporosis medication on reducing the risk of non-trauma fracture (NTFx) among adults with epilepsy. Data from 01/01/2012 to 09/30/2015 was extracted from Optum Clinformatics Data Mart. NTFx risk attenuation from 12 months prior to 12 months after the individual's index date was examined for each group of adults ≥50years of age as risk ratios (RRs with 95% confidence intervals [CIs]). Groups were stratified based on: (1) epilepsy status, as with vs without epilepsy (EP); and (2) if and when osteoporosis medication was first prescribed, as new users (treatment naive), consistent users (osteoporosis medication prescribed in pre-index period), and no users. Comparison groups were matched 1:1 to EP new users (n=828/group) for demographics, glucocorticoid and antiseizure medication, and the Elixhauser comorbidity index. Difference-in-difference analysis compared the change in pre- to post-index NTFx risk among groups as the ratio of the RR (RRR). The pre- to post-index NTFx risk at any site was reduced for EP new users (RR=0.49; 95% CI=0.40-0.61) and EP consistent users (RR=0.70; 95% CI=0.38-0.98), but nonsignificantly elevated for EP no users (RR=1.39; 95% CI=0.93-2.07)-findings were consistent for most sites (eg, vertebral column). EP new users had a larger NTFx risk attenuation at any site compared to EP no users (RRR=0.35; 95% CI=0.23-0.54) and EP consistent users (RRR=0.70; 95% CI=0.51-0.97). EP consistent users had a larger NTFx risk attenuation at any site compared to EP no users (RRR=0.50; 95% CI=0.32-0.79). The extent of NTFx risk attenuation at any site was similar for new users with vs without epilepsy (RRR=0.99; 95% CI=0.73-1.34) and consistent users with vs without epilepsy (RRR=0.81; 95% CI=0.55-1.17). There was evidence of site-specific effects (eg, hip). Osteoporosis medication is associated with a clinically meaningful 12-month NTFx risk attenuation for adults with epilepsy, especially for those just starting osteoporosis medication.
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