Trends in Media Reports, Oral Bisphosphonate Prescriptions, and Hip Fractures 1996-2012: An Ecological Analysis

Abstract

Bisphosphonates are effective for the treatment of osteoporosis despite recent reports of safety concerns such as atypical femur fracture. We conducted an ecological analysis of relevant media reports, oral bisphosphonate use, and fracture outcomes in the United States. Trends in media reports and public interest of bisphosphonates were quantified using data from Google Trends. Data from the Medical Expenditure Panel Survey (MEPS) and the National Inpatient Sample (NIS) were used to estimate the trends in oral bisphosphonate use among patients aged 55 years and older and hospitalizations for intertrochanteric and subtrochanteric fractures, respectively. These trends in the prevalence of oral bisphosphonate use and the age-adjusted incidence rate of intertrochanteric and subtrochanteric fractures were examined from 1996 to 2012. A series of spikes in Internet search activity for alendronate (Fosamax) occurred between 2006 and 2010 immediately following media reports of safety concerns. Oral bisphosphonate use declined by greater than 50% between 2008 and 2012 (p < 0.001) after increasing use for more than a decade. The decline was more common in patients with lower education levels. Intertrochanteric hip fractures declined from 1996 through 2006 (p < 0.001) and continued to decline from 2008 to 2012 (p < 0.05). Subtrochanteric and diaphyseal fractures showed a steady and significant increase from 2002 to 2011 (p < 0.05). However, the incidence decreased from a peak of 30.5 per 100,000 in 2011 to 26.7 per 100,000 in 2012. The plateauing and subsequent decline in oral bisphosphonate use since 2006 coincided with reports of safety concerns of bisphosphonates, despite the fact that U.S. Food and Drug Administration (FDA) and American Society of Bone and Mineral Research (ASBMR) reports did not recommend any safety restrictions on their use. This decline in oral bisphosphonate use was followed by the decline in the incidence of subtrochanteric and diaphyseal fractures.

Keywords: ANTIRESORPTIVES; BISPHOSPHONATE; EPIDEMIOLOGY; FRACTURE PREVENTION; GENERAL POPULATION STUDIES; OSTEOPOROSIS.

Fig. 1.

U.S. Google search activity for the term “Fosamax” from January 2004 to January 2015. Search activity is relative to the highest peak which is given a value of 100. Labeled events: A = Lawsuit filed against Merck for Fosamax causing osteonecrosis of the jaw. B = Study in Archives of Internal Medicine published associating Fosamax with atrial fibrillation. C = Jury deliberations start for first Fosamax trial. D = ABC World News runs feature segment on Fosamax and atypical femoral fractures. E = First ASBMR task force report on atypical femoral fractures published. F = FDA Advisory Committee findings on bisphosphonates and fracture risk published in New England Journal of Medicine. G = Second ASBMR task force report on atypical femoral fractures published. Data source: Google Trends (www.google.com/trends).

Fig. 2.

Prevalence of bisphosphonate use among females and males aged 55 years and older from 1996 to 2012. Data source: Medical Expenditure Panel Survey (MEPS).

Fig. 3.

National estimates of intertrochanteric fractures from 1996 to 2012 in patients aged 55 years and older. Source: National Inpatient Sample (NIS). Error bars indicate 95% CI.

Fig. 4.

National estimates of subtrochanteric fractures from 1996 to 2012 in patients aged 55 years and older. Source: National Inpatient Sample (NIS). Error bars indicate 95% CI.

Fig. 5.

Percentage normalized changes of bisphosphonate prescription and subtrochanteric and diaphyseal fractures. BIS = bisphosphonate; FX = fractures.