Bisphosphonate Prescription Research Articles

Persistence with weekly and monthly bisphosphonates among postmenopausal women: analysis of a US pharmacy claims administrative database

BackgroundBisphosphonates are available in daily, weekly, and monthly dosing formulations to treat postmenopausal osteoporosis. Some researchers suggested that adherence to monthly bisphosphonate might be different from that with weekly or daily bisphosphonate because of different dosing regimens. However, the actual persistency rates in regular practice settings are unknown.ObjectivesTo compare persistence rates with alendronate 70 mg once weekly (AOW), risedronate 35 mg once weekly (ROW), and ibandronate 150 mg once monthly (IOM) in a US pharmacy claims database.MethodsIn this retrospective cohort study, pharmacy claims data of patients with new bisphosphonate prescriptions were extracted for women aged ≥ 50 years who had an AOW, ROW, or IOM prescription (index prescription) between December 30, 2004 and May 31, 2005 (the index period) and did not have the index Rx during the previous 12 months. Patients’ records were reviewed for at least 5 months from their index date to November 2, 2005 (the follow-up period). Patients were considered persistent if they neither discontinued (failed to refill the index Rx within a 45-day period following the last supply day of the previous dispensing) nor switched (changed to another bisphosphonate) during the follow-up period. Medication-possession ratio was defined as days with index prescription supplies/total days of follow-up.ResultsAmong 44,635 patients, 25,207 (56.5%) received prescriptions of AOW, 18,689 (41.9%) ROW, and 739 (1.7%) IOM as the index prescription. In all, 35.1% of AOW patients, 32.5% of ROW patients, and 30.4% of IOM patients (P < 0.0001 AOW vs ROW or IOM) had persisted with their initial therapy, whereas 64.0% of AOW, 66.4% of ROW, and 68.2% of IOM patients discontinued (P < 0.0001) during follow-up. The medication-possession ratio (days with index prescription supplies/total days of follow-up) was significantly higher for AOW (0.55) compared with ROW (0.52) and IOM (0.51, P < 0.05). By Kaplan–Meier analysis, the time for 50% of patients to discontinue therapy was also significantly longer with AOW (109 days) compared with ROW (95 days, P < 0.05) or IOM (58 days, P < 0.05).ConclusionIn a real-world clinical setting, although persistence with all treatments was suboptimal, patients receiving prescriptions for once-weekly alendronate were more likely to be persistent than those receiving prescriptions for once-weekly risedronate or once-monthly ibandronate.

Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002–2012

Bisphosphonates have been widely prescribed to postmenopausal women for treatment and prevention of osteoporosis. Given a background of reports of recent safety problems, questions about optimal duration of use, and the patent expiration of Fosamax in February 2008, we accessed data from pharmaceutical marketing research databases to describe trends in dispensed prescriptions and sales of oral bisphosphonates, characteristics of patients and prescribers, and sales of intravenous bisphosphonates for osteoporosis treatment.An estimated 21.3million prescriptions for oral bisphosphonates were dispensed in U.S. retail pharmacies in 2002 that increased 46% to a peak of 31.0million in 2007 and 2008, and declined by 53% in a four year-period to 14.7million in 2012. Sales data (number of packages sold in all settings of care) showed parallel trends (66% increase from 2002 through 2007 and 51% decrease from 2007 through 2012). Similarly, intravenous bisphosphonate sales for osteoporosis treatment grew 3.8-fold from 149.5 thousand packages in 2007 to 561.6 thousand in 2010, followed by a 22% decrease in 2012.Data from an ongoing monthly office-based survey indicated physicians mentioned oral bisphosphonates primarily in visits of older aged Caucasian women with lower body mass for osteoporosis. Frequencies of oral bisphosphonate mentions increased between 2002 and 2012 in visits of Asians and for osteopenia diagnoses.These data indicate a substantial decline in prescriptions and sales of oral (since 2007–2008) and intravenous (since 2010) bisphosphonates for osteoporosis treatment in the United States. Reasons for, and implications of, the decline should be considered for future research.

Oral Bisphosphonates and the Risk of Barrettʼs Esophagus: Case–Control Analysis of US Veterans

This study examined Barrett's esophagus (BE) risk factors in veterans to determine the association between risk of BE and use of oral bisphosphonates. We conducted a case-control study among eligible patients scheduled for an elective esophagogastroduodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care clinics from a single VA Medical Center. Cases with definitive BE were compared with controls; all underwent study EGD. Use of oral bisphosphonates was ascertained by reviewing filled prescriptions in electronic pharmacy records. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs), using multivariate logistic regression modeling while adjusting for sex, age, race, proton-pump inhibitor use, hiatal hernia, waist-to-hip ratio, Helicobacter pylori infection, and gastroesophageal reflux disorder (GERD) symptoms. There were 285 BE cases, 1,122 endoscopy controls, and 496 primary care controls. Alendronate and risedronate were the only oral bisphosphonates prescribed. The proportion of BE cases with filled prescription of oral bisphosphonates (4.6%) was greater than in endoscopy controls (1.6%) or primary care controls (2.9%). In the adjusted analysis, oral bisphosphonate use was significantly associated with BE risk (OR=2.33; 95% CI: 1.11-4.88) compared with the combined control groups. This association remained significant when BE cases were compared with endoscopy controls only (OR=2.74; 95% CI: 1.28-5.87) but was attenuated when compared with primary care controls only (OR=2.60; 95% CI: 0.99-6.84). The association was observed in patients with GERD symptoms (OR=3.29; 95% CI: 1.36-7.97) but not in those without GERD symptoms. Oral bisphosphonate use may increase the risk for BE, especially among patients with GERD.

AB0622 Significance of body mass index for the effect of bisphosphonate therapy in women with postmenopausal osteoporosis

BackgroundOsteoporosis is generalized bone disease characterized by disturbed bone strength, consequently fracture predisposition increases. One of the risk factors for osteoporotic fractures is the Body Mass Index (BMI) and it...

Effectiveness of risedronate and alendronate on nonvertebral fractures: an observational study through 2 years of therapy

This observational study showed that after 2 years, both risedronate and alendronate lowered the risk of hip and nonvertebral fractures compared with patients filling in a single bisphosphonate prescription. Post hoc analyses of the placebo-controlled trials suggested earlier effects for risedronate (6-12 months) than for alendronate (18-24 months). The present study extends our 1-year observational data that confirmed an earlier fracture reduction with risedronate and evaluated the absolute and relative effectiveness of alendronate and risedronate in clinical practice over 2 years. We observed three cohorts of women aged 65 years and older who initiated once-a-week dosing of bisphosphonate therapy; (1) patients adherent to alendronate (n = 21,615), (2) patients adherent to risedronate (n = 12,215), or (3) patients filling only a single bisphosphonate prescription (n = 5,390) as a referent population. Proportional hazard modeling compared the incidence of hip and nonvertebral fractures among the cohorts over 2 years after the initial prescription. In this cohort, we previously showed at 12 months a significant reduction of hip and nonvertebral fractures with risedronate but not with alendronate. At the end of 2 years, the cumulative incidence of hip fractures in the referent cohort was 1.9 %, and incidence of nonvertebral fractures was 6.3 %. Relative to the referent, 6 months after initiating therapy and continuing through 2 years, both risedronate and alendronate cohorts had approximately a 45 % lower incidence of hip fractures and a 30 % lower incidence of nonvertebral fractures. These observations suggest that both risedronate and alendronate are effective at reducing the risk of hip and nonvertebral fracture after 2 years of treatment and support the post hoc analyses of placebo-controlled trials indicating an earlier effect of risedronate.

Primary non-adherence to bisphosphonates in an integrated healthcare setting

We estimated primary non-adherence to oral bisphosphonate medication and examined the factors associated with primary non-adherence. Nearly 30% of women did not pick up their new bisphosphonate within 60 days. Identifying barriers and developing interventions that address patients' needs and concerns at the time a new medication is prescribed are warranted. To estimate primary non-adherence to oral bisphosphonate medications using electronic medical record data in a large, integrated healthcare delivery system and to describe patient and prescribing provider factors associated with primary non-adherence. Women aged 55 years and older enrolled in Kaiser Permanente Southern California (KPSC) with a new prescription for oral bisphosphonates between December 1, 2009 and March 31, 2011 were identified. Primary non-adherence was defined as failure to pick up the new prescription within 60 days of the order date. Multivariable logistic regression models were used to investigate patient factors (demographics, healthcare utilization, and health conditions) and prescribing provider characteristics (demographics, years in practice, and specialty) associated with primary non-adherence. We identified 8,454 eligible women with a new bisphosphonate order. Among these women, 2,497 (29.5%) did not pick up their bisphosphonate prescription within 60 days of the order date. In multivariable analyses, older age and emergency department utilization were associated with increased odds of primary non-adherence while prescription medication use and hospitalizations were associated with lower odds of primary non-adherence. Prescribing providers practicing 10 or more years had lower odds of primary non-adherent patients compared with providers practicing less than 10 years. Internal medicine and rheumatology providers had lower odds of primary non-adherent patients than primary care providers. This study found that nearly one in three women failed to pick up their new bisphosphonate prescription within 60 days. Identifying barriers and developing interventions aimed at reducing the number of primary non-adherent patients to bisphosphonate prescriptions are warranted.

Persistence with bisphosphonates in patients with metastatic breast cancer: a retrospective database analysis

In women with breast cancer and bone metastasis, compliance to antiresorptive treatment is of upmost importance to ensure maximum effectiveness in clinical practice. The aim of our study was to investigate persistence with oral and intravenous bisphosphonates (BIS) in a large group of women with metastatic breast cancer and to identify the determinants of non-persistence. We used data from the Disease Analyzer database (IMS Health, Germany), which includes 2,067 general practices and 397 gynaecological practices. From a dataset of 20 million patients, we identified 1,045 patients diagnosed between January 2001 and December 2010 with bone metastasis (ICD 10: C795) following breast cancer (ICD 10: C50) with first-time cancer-related bisphosphonate prescriptions (ATC: M03B4). Of these, 763 patients received intravenous treatment, and 280 patients received oral BIS treatment. After 1 year, 35.3 % of patients treated with intravenous, and 45.6 % of patients treated with oral bisphosphonates discontinued their therapy (p = 0.002). Multivariate Cox Regression analyses showed a significant increased risk of treatment discontinuation in patients using intravenous BIS (HR: 0.82) compared with oral BIS. Patients younger than 50 (HR: 1.52) were most likely to discontinue treatment compared with the reference group of women over 70. The use of other treatments, such as chemotherapy or hormone therapy, was associated with a decreased risk of treatment discontinuation. Moreover, treatment discontinuation was higher in West Germany compared with East Germany (HR: 1.65) and in patients covered under private health insurance (HR: 1.33). Persistence with all bisphosphonate treatments in women with breast cancer and bone metastasis is low and needs to be significantly increased to improved outcomes in clinical practice. Further research is required to understand this complex issue.

Summary of: A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital

The aim of this retrospective study was to examine the outcome of patients referred to a dedicated clinic for dental extractions while they were prescribed either oral or intra-venous (IV) bisphosphonates (BPs). The following parameters were assessed: mode of BP administration, indication for BP prescription, incidence of BRONJ, concomitant risk factors for development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and demographic details. The clinical records of 225 patients who underwent dental extraction while receiving oral or intravenous bisphosphonates were reviewed. Their clinical outcome, specifically the development of BRONJ was determined. Of the 225 patients, 202 were prescribed oral and 23 IV BPs. 34.8% (8/23) of patients prescribed IV BPs developed BRONJ following dental extraction, which was a significantly (p <0.001) higher proportion than that of the oral BP group, which was 2.5% (5/202 patients). 12.3% (8/65) patients taking BPs with steroids were at a significantly increased risk of a BRONJ (p <0.003). 12.3% (7/57) males developed a BRONJ compared with 3.6% (6/168) females where p = 0.015. All of the patients who developed a BRONJ as a result of oral BP prescription had been taking this medication for three years or more. In our patient cohort the risk of developing a BRONJ following dental extractions was greatest in those patients receiving IV BPs and those on oral BPs with concomitant steroid medication.

A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital

The aim of this retrospective study was to examine the outcome of patients referred to a dedicated clinic for dental extractions while they were prescribed either oral or intra-venous (IV) bisphosphonates (BPs). The following parameters were assessed: mode of BP administration, indication for BP prescription, incidence of BRONJ, concomitant risk factors for development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and demographic details. The clinical records of 225 patients who underwent dental extraction while receiving oral or intravenous bisphosphonates were reviewed. Their clinical outcome, specifically the development of BRONJ was determined. Of the 225 patients, 202 were prescribed oral and 23 IV BPs. 34.8% (8/23) of patients prescribed IV BPs developed BRONJ following dental extraction, which was a significantly (p <0.001) higher proportion than that of the oral BP group, which was 2.5% (5/202 patients). 12.3% (8/65) patients taking BPs with steroids were at a significantly increased risk of a BRONJ (p <0.003). 12.3% (7/57) males developed a BRONJ compared with 3.6% (6/168) females where p = 0.015. All of the patients who developed a BRONJ as a result of oral BP prescription had been taking this medication for three years or more. In our patient cohort the risk of developing a BRONJ following dental extractions was greatest in those patients receiving IV BPs and those on oral BPs with concomitant steroid medication.

GRP-150 Prescription of Bisphosphonates in Chronically Institutionalised Patients

BackgroundOsteoporosis is associated with significant morbidity and mortality. Oral bisphosphonates have become a mainstay of treatment, but concerns have emerged that long-term use of these drugs may suppress bone remodelling,...

Decreasing Frequency of Osteonecrosis of the Jaw in Cancer and Myeloma Patients Treated with Bisphosphonates: The Experience of the Oncology Network of Piedmont and Aosta Valley (North-Western Italy)

Background. Data concerning frequency of Osteonecrosis of Jaws (ONJ) are mostly based on single center experiences. Patients and Methods. Since 2005 a multidisciplinary study group collected data of cases of ONJ in patients treated with Bisphosphonates (BP) and observed in oncology and hematology centers of a regional network. Results. By December 2008, 221 cases were registered. We report details of 200 cases, identified after cross-checking reports from centres of medical oncology, haematology, and oral care. Primary neoplasm was breast cancer (39%), myeloma (32%), prostate cancer (16%), and other types of cancer (8%). In about 50% of the cases a history of dental extraction was present. Zoledronic acid was administered (alone or with other BP) to 178 patients (89%). Median time from first infusion to ONJ diagnosis was 21.0 (zoledronic acid only) and 39.0 months (pamidronate only). The number of ONJ cases per year was 3 in 2003, 21 in 2004, 58 in 2005, 60 in 2006, 37 in 2007, and 21 in 2008. Conclusion. The number of new ONJ cases in cancer and myeloma patients increased until 2006 and then reduced. The possible reasons of this trend (introduction of zoledronic acid; increase of ONJ awareness; diffusion of preventive dental measures; late modifications of BP prescription) are herein discussed.

BRONJ: A Word of Caution in Bisphosphonate Prescription

We describe the case of an elderly female who had received IV bisphosphonates (Zoledronic acid) and had presented with a non healing tooth socket after tooth removal. The patient was managed conservatively with local curettage and recovered from the jaw problem.

BRONJ: A Word of Caution in Bisphosphonate Prescription

We describe the case of an elderly female who had received IV bisphosphonates (Zoledronic acid) and had presented with a non healing tooth socket after tooth removal. The patient was managed conservatively with local curettage and recovered from the jaw problem. Keywords: IV bisphosphonates, Bisphosphonate-related osteonecrosis of the jaws, BRONJ, Non healing tooth socket, Zoledronate. Read more →

Reality and Recommendation: Comparison between Current Practice Patterns in a Single Center in Taiwan and the ACR 2010 Recommendations for Glucocorticoid-induced Osteoporosis Treatment among Elderly Patients with Systemic lupus Erythematosus, Polymyositis, and Dermatomyositis

Objectives: To compare current practice patterns with the American College of Rheumatology (ACR) 2010 recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients over 65 with systemic lupus erythematosus (SLE), polymyositis (PM), or dermatomyositis (DM). Methods: Thirty-eight patients aged above 65 as of October 2009 were included in our study. We retrospectively collected clinical data from electronic medical records and stratified patients into high-, medium-, and low-risk groups based on Fracture Risk Assessment (FRAX) score, history of prior fragility fracture, and bone mineral density, according to the new ACR recommendations. Using the Taiwan version of the FRAX tool, we created a diagram that can serve as a quick reference for corresponding risk stratification in patients in Taiwan receiving corticosteroids. We then identified corresponding treatment choices according to the ACR recommendation and recorded the dose and duration of corticosteroid administration from October 2009 to September 2010. We compared actual prescribing practice to the recommended practice. Multiple variable logistic regression was performed to identify factors that affected adherence to recommendations. Results: Out of 38 patients who fulfilled the inclusion criteria, 31.6% were classified as low risk, 26.3% as medium risk, and 42.1% as high risk. Although pharmacologic interventions for the prevention and treatment of GIOP were recommended for 89.5% overall, and for 66.7%, 100%, and 100% in the low-, medium-, and high-risk groups, respectively, only 14 of the 38 patients (36.8%) in our study received any kind of bisphosphonate or teriparatide to treat or prevent osteoporosis. Specifically, among the 34 patients in our study who met the ACR recommendations to receive pharmacologic interventions, only 13 (38.2%) received antiresorptive medications or teriparatide according to the recommendations, including 1 patient out of 8 (12.5%) in the low-risk group, 3 patients out of 10 (30.0%) in the medium-risk group, and 9 patients out of 16 (56.3%) in the high-risk group. The multivariate logistic regression model showed that past history of osteoporotic fracture was associated with prescription of bisphosphonates or teriparatide (odds ratio = 47.00; 95% confidence interval =1.07 - 2063.68; p=0.046). Conclusion: Much discrepancy exists between the ACR 2010 recommendations and current practices for prevention and treatment of GIOP in patients over 65 who are diagnosed with SLE, PM, or DM. More efforts against GIOP should be made.

Bisphosphonates and risk of upper gastrointestinal cancer--a case control study using the General Practice Research Database (GPRD).

BackgroundConcerns have been raised as to the safety of bisphosphonates; in particular a possible link between bisphosphonate use and upper gastrointestinal (GI) cancer. Two published studies using different study populations but drawn from earlier versions of the same national UK database, reached differing conclusions: one finding no evidence for an increase in the risk of gastric or oesophageal cancer in bisphosphonate users and one finding a small but significantly increased risk of oesophageal cancer linked to duration of bisphosphonate use.Methodology/ Principal FindingsDesign-A case control study comparing bisphosphonate prescribing in cases of upper GI cancer from 1995 to 2007 using UK primary care electronic health records (GPRD).Main Outcome Measure-Relative Risk (approximated to Odds Ratio for rare events) for oesophageal and gastric cancer development in bisphosphonate users compared to non–users. The odds of being a case of oesophageal cancer, adjusted for smoking status, were significantly increased in women who had had one or more bisphosphonate prescriptions, odds ratio 1·54 (95% CI 1·27–1·88) compared to non-users. There was no significant effect on gastric cancer in women, odds ratio adjusted for smoking status, 1.06 (95% CI 0.83–1.37) and also no apparent risk in men for either oesophageal or gastric cancer, odds ratio adjusted for smoking status 0.78 (95%CI 0.56–1.09) and 0.87 (95% CI 0.55–1.36) respectively.Conclusions/ SignificanceOur results support a small but significant increased risk of oesophageal cancer in women prescribed bisphosphonates and is based on the largest number of exposed cases to date in the UK.

Oral bisphosphonate use in the elderly is not associated with acute kidney injury

Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR <60 ml/min per 1.73 m(2)). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.

Do the hospitalized patients with osteoporotic fractures require endocrinologists' help?

Osteoporotic fractures are a crucial cause of morbidity and mortality in patients with fragility fractures and impose huge economic burden on health care services. Orthopedic surgeons are often the only clinicians seen by the patients with osteoporotic fractures. The improvement in osteoporosis management is an urgent require; therefore, the aim of this study was to determine the efficacy of consultation with an endocrinologist in osteoporosis management of patients with a fragility fracture. This survey was undertaken in three phases that focused on patients with osteoporotic fractures who were admitted to five tertiary care, level-I, trauma hospital. Patients were evaluated through a questionnaire which was designed to determine whether physicians manage underlying osteoporosis. The number of patients who underwent a bone mineral density test increased from a rate of 3.6% to 91% after the intervention, as calcium and vitamin D supplementation from 18% to 92%, bisphosphonate prescription from 0.5% to 83%. Also, the overall medication usage increased from 9% to 87%. A small number of patients (3%) were followed up in contrast to a rate of 73% in the third phase. Orthopedic surgeons are not completely engaged in osteoporosis care for patients with a fragility fracture; therefore, a consultation with an endocrinologist is required to enable orhopedic surgeons to provide an effective osteoporosis care for their patients with an osteoporotic fracture.

Bisphosphonate use and increased incidence of subtrochanteric fracture in South Korea: results from the National Claim Registry

We evaluated trends in the incidences of typical and atypical hip fracture in relation to bisphosphonate use in Korea from 2006 to 2010, using nationwide data obtained from the Health Insurance Review and Assessment Service (HIRA). Recently, atypical hip fractures in the subtrochanteric region have been reported among patients on bisphosphonate. However, the association between atypical hip fracture and bisphosphonate is controversial. We evaluated trends in the incidences of typical and atypical hip fracture in relation to bisphosphonate use in Korea from 2006 to 2010, using nationwide data obtained from the HIRA. All new visits or admissions to clinics or hospitals for a typical and atypical hip fractures were recorded nationwide by HIRA using the ICD-10 code classification. Typical and atypical hip fractures were defined as femoral neck/intertrochanteric and subtrochanteric fracture, respectively. Bisphosphonate prescription data were also abstracted from the HIRA database. The absolute number of typical and atypical hip fracture increased during the study period. Although age-adjusted incidence rates of typical hip fractures were stable in men and women, those of atypical hip fractures increased in women. Nationally, the annual numbers of prescriptions of bisphosphonate also increased during the study period. The results of this study suggest a possible causal relationship between bisphosphonate use and the increased incidence of atypical hip fracture in Korea.

Are long-term bisphosphonate users a reality? Dose years for current bisphosphonate users assessed using the danish national prescription database

The prevalence of long-term bisphosphonate use may be low due to low refill compliance and gaps in treatment. An analysis of the prescription history of 58,674 bisphosphonate users in Denmark found that only 2.8% had received ten dose years of treatment or above. This study aims to describe the demographics of present bisphosphonate (BP) users, to determine the prevalence of long-term BP use, and to establish if long-term use (a 10-year history of osteoporosis treatment) translated to ten dose years of bisphosphonate prescriptions filled, given the propensity for treatment gaps and low refill compliance with bisphosphonates. The study population was all persons aged 35 and above, who had filled at least one prescription for an oral bisphosphonate in the year 2008. Past use of osteoporosis medications (bisphosphonates, raloxifene, strontium ranelate, or PTH analogs) for the period January 1, 1995 to December 31, 2007 was retrieved from the Danish National Prescription Database for descriptive analysis. Of the 58,674 BP users, 46% were above the age of 75, and 13% were men. Though 5.9% had at least a 10-year history of treatment, only half (2.8%) had received more than ten dose years of a BP. For any osteoporosis drug, 3.0% had received ten dose years or more, while 23.2% had received between 5 and 10years of treatment. Long-term users with ten dose years or more of a BP are rare due to periods of low compliance and gaps, with a discrepancy between the length of treatment and doses taken. The study also highlights the great number of patients who have used BP for more than five dose years and should be advised on length of treatment, a decision process that will be difficult due to the paucity of long-term safety and efficacy data.

Alendronate-Induced Osteonecrosis of the Jaw in an Elderly Female

Summary Background In recent years, more and more evidence has demonstrated that a rare symptom, osteonecrosis of the jaw, may be associated with long-term use of bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) adversely affects the quality of life, producing significant morbidity in afflicted patients. The most common signs and symptoms are swelling, exposed bone, local infection, pathologic fracture of the jaw, etc. Patients and methods We report the case of an elderly female patient with alendronate-induced ONJ. After the patient discontinued taking bisphosphonates and her physician prescribed antiseptic mouthwashes and antibiotic drugs, her uncomfortable symptoms were relieved. Results This side effect rarely occurs in Taiwan; it causes permanent harm to patients. Moreover, it affects the normal function of taking food. Therefore, this article includes a case report and a list of some related papers systematically providing clinicians with a reference for future prescription of bisphosphonates. Conclusion Furthermore, we provide suggestions for the Mackay Memorial Hospital and dentists, in anticipation of earlier measures being taken in order to avoid bisphosphonaterelated osteonecrosis, and to reduce additional medical expenses resulting from this side effect.