Session Type: Abstract Submissions (ACR)
Adherence to drug therapy may be a surrogate marker for overall healthy behaviors leading to healthy-adherer bias in epidemiologic studies. This might be particularly emphasized in osteoporosis supplements and medications. However, individual factors contributing to healthy-adherer effects and their quantitative impacts are not well described. We assessed the association between prevalent use of and adherence to osteoporotic supplements or medications and healthy lifestyle factors in a population-based sample from the National Health and Nutrition Examination Survey, 1999-2008.
We identified subjects who used calcium plus vitamin D supplements and/or osteoporotic medications (bisphosophonate, calcitonin or raloxifene). We estimated the magnitude of association between prevalent use of these osteoporotic drugs and demographic, lifestyle and comorbid illness factors. Demographic, lifestyle, and comorbid factors of interest included body mass index, exercise, smoking, alcohol consumption, self-reported health status, comorbidities (cancer, coronary artery disease, COPD and diabetes), and steroid use. We also examined the subset of subjects with a history of fracture in the hip, wrist or spine, or those with osteoporosis who were advised to take treatments.
Among 25,290 subjects, 1,529 were users and 23,761 were nonusers of calcium, vitamin D or an osteoporosis medication. Users and nonusers were similar in age (mean age 57 years), but were more likely to be women (64% vs 52%; P < .05). After adjustment for age, prevalent female users 50 years or older had significantly less severe obesity (odds ratio 0.7, 95% CI: 0.6, 0.9), current or past smoking (OR 0.8, 95% CI: 0.5, 1.0), more moderate exercise (OR 1.4, 95% CI:1.1, 1.8), lower self-reported poor health (OR 0.8, 95% CI: 0.7, 0.9), less diabetes (OR 0.7, 95% CI:0.6, 0.9) and acute coronary syndrome (OR 0.8, 95% CI:0.7, 1.0). Among subjects with previous fracture or osteoporosis, a similar trend was seen between users and nonusers.
In a large representative US population, prevalent use or adherence to osteoporotic drugs was associated with healthier lifestyle factors. The results suggest that healthy user or adherer can be explained, in part, by the healthier lifestyles in prevalent users or adherers in the elderly.
D. H. Solomon,
Amgen & Lilly,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/contribution-of-lifestyle-factors-to-healthy-adherer-bias-in-prevalent-users-of-osteoporotic-drugs/