Background/Purpose: Osteoporosis (OP) affects an estimated 2 million men in the United States. The relationship between treatment and fracture outcomes has been reported from clinical trial populations, but little is known about the impact of treatment on fracture risk among men with OP in the real-world setting.

Methods: The MarketScan® Medicare Supplemental and Coordination of Benefits Database was used to identify treated (received an OP medication) and untreated (had an OP diagnosis or fragility fracture but no OP medication) men with OP between 1/1/04 and 4/30/10 and at least 12 months pre-period and 3 months post-period follow-up in the database.  Patients were matched on pre-period fracture and age (± 2 years).  Follow-up time was variable and ended with fracture, inpatient death, end of health plan eligibility, or on 4/30/10, whichever came first.  Fracture incidence rates and time to fracture were reported.  A Cox proportional hazards model was used to assess whether treated men had a lower risk of fracture compared to untreated men after controlling for demographic and clinical characteristics.

Results: Of the 3,072,696 men ≥65 years in the database, a total of 31,696 men met the inclusion and match criteria (15,848 in each cohort).  In both cohorts, the mean age was 78 years and 55% had a pre-period fracture.  1,990 treated men had a follow-up fracture [incidence = 5.98/100 person-years (p-y)] over 33,274 p-y of follow-up, compared to 2,231 untreated men with a follow-up fracture (incidence = 8.03/100 p-y) over 27,785 p-y.  Treated men also had longer mean time to fracture (588 days, SD 426) than untreated men (401 days, SD 372, p<0.001).  The adjusted risk of fracture was lower among treated men compared to untreated men (adjusted hazards ratio = 0.83, 95% CI: 0.78 to 0.89).  Other pre-period factors associated with an increased risk of fracture were urban residence, no bone mineral density test, use of benzodiazepines, and a higher number of comorbidities and concomitant medications.

Conclusion:

The fracture incidence rate was lower and time to fracture was longer for men with OP who received treatment than for those without treatment. After controlling for prior fracture and other risk factors, treated men had a lower adjusted risk of fracture.  To better characterize the benefit of OP treatment, more research is needed into the role of medication adherence and risk of fracture among men with OP.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-fracture-among-treated-and-untreated-men-with-osteoporosis/