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Association between pharmacotherapy and secondary hip fracture in a real-world setting: a nationwide database study

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Abstract

Introduction

This study aimed to assess the association between pharmacotherapy and secondary hip fracture incidence.

Materials and methods

The correlation between secondary hip fracture incidence and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

Results

Data collected from female patients (n = 1,435,347) were analyzed. The 2-year secondary hip fracture incidence was 3.48% (n = 49,921). Secondary hip fracture was significantly more common in patients without medications (3.80%) than in those with medications (3.00%). Patients receiving selective estrogen receptor modulators (SERMs) had the lowest average age. The crude incidence of secondary hip fracture was the lowest in patients receiving SERMs (n = 2088 [2.52%]), followed by those taking bisphosphonates (n = 11,355 [2.88%]), denosumab (n = 1118 [2.90%]), no medications (n = 32,747 [3.80%]), and parathyroid hormone (PTH: n = 2163 [4.55%]), whereas the age-adjusted incidence was the lowest in patients administered denosumab (2.27%), followed by those taking bisphosphonates (2.47%), SERMs (2.55%), PTH (3.67%), and no medications (3.80%). The mean MPR was the highest in patients taking denosumab (64.9%), followed by those receiving bisphosphonates (58.7%), SERMs (58.2%), and PTH (40.6%) in the no hip fracture group.

Conclusion

Secondary hip fractures were less likely to occur with medication versus no medication. Differences in the crude incidence of secondary hip fracture based on medications usage might be attributed to background characteristics.

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Availability of data and materials

Permission from the Ministry of Health, Labour and Welfare is required for the use of all data and materials.

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Acknowledgements

We thank Enago (https://www.enago.jp) for their English-language editing services.

Funding

This study was partly supported by the 28th Pfizer Health Research Grant, 52nd (2019) Medical Research Grant from Taijyu Life Welfare Foundation and 2020 Research Grant from Japan Osteoporosis Foundation. The funding bodies had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Asahi General Hospital, 477 Tomari, Asahimachi, Shimo-Niikawa-gun, Toyama, 939-0798, Japan

    Shinichi Nakatoh

  2. Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Kenji Fujimori

  3. Department of Regulatory Science, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, HorinouchiTokyo, Hachiouji, 1432-1192-0392, Japan

    Shigeyuki Ishii

  4. Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan

    Junko Tamaki

  5. Okimoto Clinic, 185-4, Kubi, Yutaka-machi, Kure-City, Hiroshima, 734-0304, Japan

    Nobukazu Okimoto

  6. Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Sumito Ogawa

  7. Department of Public Health, Kindai University Faculty of Medicine, 377-2, Oono-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan

    Masayuki Iki

  8. National Database Japan-Osteoporosis Management Study Group, Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Shinichi Nakatoh, Kenji Fujimori, Shigeyuki Ishii, Junko Tamaki, Nobukazu Okimoto, Sumito Ogawa & Masayuki Iki

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  1. Shinichi Nakatoh
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  7. Masayuki Iki
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Contributions

SN: study conception and design, data analysis and interpretation, article drafting, critical revisions of the article for important intellectual content, and final approval. KF: full access to all study data and responsible for the integrity of data and accuracy of data analysis. SI, JT, NO, JO, and MI: study conception and design, critical revisions of the article for important intellectual content, and final approval.

Corresponding author

Correspondence to Shinichi Nakatoh.

Ethics declarations

Conflict of interest

S. Nakatoh has received payments for lectures, including speakers' bureau fees, from Asahi-Kasei Pharmaceutical Co., Ltd.; Amgen K.K.; and Astellas Pharma Inc. N. Okimoto has received consulting fees from Asahi-Kasei Pharmaceutical Co., Ltd. and Teijin Pharma Ltd. N. Okimoto has received payments for lectures, including speakers' bureau fees from Asahi-Kasei Pharmaceutical Co., Ltd.; Amgen Astellas Bio Pharma K.K.; Astellas Pharma Inc.; Chugai Pharmaceutical Co.; Daiichi-Sankyo Co., Ltd.; Eisai Co., Ltd.; Eli Lilly Japan; and Teijin Pharma Ltd. The other authors have no conflicts of interest to declare.

Ethical approval

The study was conducted according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Kindai University Faculty of Medicine (approval number: 31–065).

Consent to participate and consent for publication

The study data were completely anonymized. All data used in our analysis were deidentified by the Ministry of Health, Labour and Welfare. This study was performed in accordance with the guidelines of the Ministry of Information Security. Thus, informed consent was not required.

Informed consent

The data in this study were completely anonymous. All data used in our analysis were deidentified by the Ministry of Health, Labour and Welfare, and this study followed the guidelines of the Ministry of Information Security. Thus, informed consent was not required.

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Nakatoh, S., Fujimori, K., Ishii, S. et al. Association between pharmacotherapy and secondary hip fracture in a real-world setting: a nationwide database study. J Bone Miner Metab 41, 248–257 (2023). https://doi.org/10.1007/s00774-023-01411-4

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  • DOI: https://doi.org/10.1007/s00774-023-01411-4

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