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The Effect of Osteoporosis Medication on Risk Attenuation of Non-Trauma Fracture Among Adults with Cerebral Palsy: A Propensity Score-Matched Observational Study

Authors Whitney DG, Hurvitz EA, Caird MS

Received 4 December 2020

Accepted for publication 8 January 2021

Published 12 February 2021 Volume 2021:13 Pages 91—102

DOI https://doi.org/10.2147/CLEP.S294202

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Henrik Toft Sørensen


Daniel G Whitney,1,2 Edward A Hurvitz,1 Michelle S Caird3

1Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; 3Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

Correspondence: Daniel G Whitney University of Michigan, 325 E. Eisenhower Pkwy, Ann Arbor, MI, 48108, USA
Tel +1 734-936-7175
Email dgwhit@umich.edu

Purpose: The efficacy of osteoporosis medication on reducing the risk of non-trauma fracture (NTFx) among adults with cerebral palsy (CP) has not been comprehensively investigated. There are many logistical and biological factors that may reduce this efficacy, and therefore requires attention. The purpose of this propensity score-matched, observational cohort study was to determine if osteoporosis medication was associated with NTFx risk attenuation among adults with CP and compared to adults without CP.
Materials and Methods: Data from 07/01/2011 to 09/30/2015 were extracted from Optum Clinformatics® Data Mart. Claims identified adults (≥ 18 years), CP, osteoporosis medication, pre-index NTFx (6-months), and post-index NTFx (12-months). CP without osteoporosis medication (CPMeds-) and without CP with Meds (non-CPMeds+; reflects “background” population) served as controls and were matched (6:1 ratio) to adults with CP with Meds (CPMeds+; n=306). The Meds groups were further stratified by the initiation of their medication as new users or consistent users. Changes in the prevalence of NTFx from pre- to post-index periods were examined with risk ratios (RR) and the change was compared among groups using the ratio of the RR (RRR) via difference-in-difference analysis.
Results: New users with CP had: a larger risk attenuation of any NTFx compared to CPMeds- (RRR=0.39; 95% CI=0.22– 0.71), which was consistent for vertebral column/hip and lower extremities; a larger risk attenuation for NTFx of the lower extremities compared to consistent users with CP (RRR=0.22; 95% CI=0.05– 0.93); and a similar risk attenuation of any NTFx compared to new users without CP (RRR=0.81; 95% CI=0.45– 1.43), which was consistent for vertebral column/hip and lower extremities.
Conclusion: The findings suggest that osteoporosis medication is associated with clinically meaningful risk attenuation of NTFx, especially for new users with CP.

Keywords: cerebral palsy, fracture, osteoporosis medication

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