Antiresorptive drugs and the risk of femoral shaft fracture in men and women with osteoporosis: A cohort study using the National Database of Health Insurance Claims of Japan.

ObjectiveThis study aimed to estimate incidence rates of femoral shaft fracture in patients who were treated with antiresorptive drugs.DesignCohort studyMethodsWe used data from the National Database of Health Insurance Claims of Japan from April 2009 and October 2016. All patients with new use of an antiresorptive drug, prescription-free period of ≥3 months, and no prior femoral fractures were included. Femoral shaft fractures were identified using a validated definition based on ICD-10 codes. Incidence rate ratios were estimated using Poisson regression with adjustment for sex, age, and the Charlson Comorbidity Index.ResultsWe identified 7,958,655 patients (women, 88.4%; age ≥75 years, 51.2%). Femoral shaft fractures were identified in 22,604 patients. Incidence rates per 100,000 person-years was 74.8 for women, 30.1 for men, 30.1 for patients aged ≤64 years, 47.7 for patients aged 65-74 years, and 99.0 for patients aged ≥75 years. Adjusted incidence rate ratios in patients taking versus not taking each type of antiresorptive drug were 1.00 (95% confidence interval (CI), 0.98-1.03) for bisphosphonates, 0.46 (95% CI, 0.44-0.48) for selective estrogen receptor modulators, 0.24 (95% CI, 0.18-0.32) for estrogens, 0.75 (95% CI, 0.71-0.79) for calcitonins, and 0.93 (95% CI, 0.84-1.03) for denosumab. The adjusted incidence rate ratio for alendronate was 1.18 (95% CI, 1.14-1.22).ConclusionsThe incidence rates of femoral shaft fracture varied across patients treated with different antiresorptive drugs. Further research on a specific antiresorptive drug can increase understanding of the risk of femoral shaft fracture.