(2016). Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales: An Interrupted Time-Series Analysis. Journal of Bone and Mineral Research , 31 (11), 2008-2015.

In January 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of antiosteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorization of a generic form of alendronic acid within the UK. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of antiosteoporosis medication prescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999 to 2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year “ intervention period. ” We identi fi ed 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% CI, 10.9 to 18.9) for incident antiosteoporosis prescriptions and a signi fi cant and clinically important reduction in subsequent major and subsequent hip fracture: – 0.19% (95% CI, – 0.28 to – 0.09) and – 0.17% (95% CI, – 0.26 to – 0.09) per 6 months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at 3 years postintervention relative to expected values based solely on preintervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a signi fi cant decline in subsequent fractures. © 2016 American Society for Bone and Mineral Research.

[1]  C. Cooper,et al.  Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study , 2016, Age and ageing.

[2]  C. Cooper,et al.  Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates: A Binational Population‐Based Cohort Study , 2016, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[3]  A. Farmer,et al.  Secondary prevention of fractures after hip fracture: a qualitative study of effective service delivery , 2016, Osteoporosis International.

[4]  M. K. Javaid,et al.  Impact of hip fracture on hospital care costs: a population-based study , 2015, Osteoporosis International.

[5]  Evangelos Kontopantelis,et al.  Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis , 2015, BMJ : British Medical Journal.

[6]  K. Bhaskaran,et al.  Data Resource Profile: Clinical Practice Research Datalink (CPRD) , 2015, International journal of epidemiology.

[7]  P. Geusens,et al.  Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study , 2015, Osteoporosis International.

[8]  G. Collins,et al.  Overdiagnosis of bone fragility in the quest to prevent hip fracture , 2015, BMJ : British Medical Journal.

[9]  K. Michaëlsson,et al.  Osteoporosis: the emperor has no clothes , 2015, Journal of internal medicine.

[10]  H. Leufkens,et al.  Anti-osteoporosis drug prescribing after hip fracture in the UK: 2000–2010 , 2015, Osteoporosis International.

[11]  B. Prendergast,et al.  Incidence of infective endocarditis in England, 2000–13: a secular trend, interrupted time-series analysis , 2015, BDJ.

[12]  J. Achten,et al.  Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation--a prospective cohort study. , 2015, The bone & joint journal.

[13]  H. Leufkens,et al.  The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000–2010 , 2014, Osteoporosis International.

[14]  M. Oddy,et al.  Failure in the application of fragility fracture prevention guidelines. , 2014, Annals of the Royal College of Surgeons of England.

[15]  C. Cooper,et al.  Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England , 2014, Osteoporosis International.

[16]  Robert B. Penfold,et al.  Use of interrupted time series analysis in evaluating health care quality improvements. , 2013, Academic pediatrics.

[17]  J. Gilliland,et al.  Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces , 2013, Osteoporosis International.

[18]  P. Kannus,et al.  Continuous decline in incidence of hip fracture: nationwide statistics from Finland between 1970 and 2010 , 2013, Osteoporosis International.

[19]  J. Eisman,et al.  Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis , 2013, Osteoporosis International.

[20]  J. Eisman,et al.  Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates. A NOREPOS study , 2012, European Journal of Epidemiology.

[21]  A. Roddam,et al.  Persistence with osteoporosis medications among postmenopausal women in the UK General Practice Research Database , 2012, Menopause.

[22]  S. Beard,et al.  Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision , 2011, Osteoporosis International.

[23]  W. Srikusalanukul,et al.  Bisphosphonate use and hip fracture epidemiology: ecologic proof from the contrary , 2010, Clinical interventions in aging.

[24]  M. Safford,et al.  Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. , 2010, Journal of the American Medical Directors Association.

[25]  P. Vestergaard,et al.  Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006 , 2010, Osteoporosis International.

[26]  W. Leslie,et al.  Trends in hip fracture rates in Canada. , 2009, JAMA.

[27]  Fang Zhang,et al.  Methods for estimating confidence intervals in interrupted time series analyses of health interventions. , 2009, Journal of clinical epidemiology.

[28]  T. Therneau,et al.  Secular trends in hip fracture incidence and recurrence , 2009, Osteoporosis International.

[29]  Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit , 2008, Quality & Safety in Health Care.

[30]  P. Tugwell,et al.  Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. , 2008, The Cochrane database of systematic reviews.

[31]  S. Boonen,et al.  Zoledronic acid and clinical fractures and mortality after hip fracture. , 2007, The New England journal of medicine.

[32]  A. Tosteson,et al.  Incidence and Economic Burden of Osteoporosis‐Related Fractures in the United States, 2005–2025 , 2007, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[33]  A. Feldstein,et al.  Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. , 2003, Archives of internal medicine.

[34]  A K Wagner,et al.  Segmented regression analysis of interrupted time series studies in medication use research , 2002, Journal of clinical pharmacy and therapeutics.

[35]  S. Cummings,et al.  Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. , 2000, The Journal of clinical endocrinology and metabolism.

[36]  L Abenhaim,et al.  The use of a large pharmacoepidemiological database to study exposure to oral corticosteroids and risk of fractures: validation of study population and results , 2000, Pharmacoepidemiology and drug safety.