Association between bisphosphonate therapy and outcomes from rehabilitation in older people

James A. Goodbrand, Lloyd D. Hughes, Lynda Cochrane, Peter Donnan, Mark McGilchrist, Helen Frost, Marion McMurdo, Miles Witham (Lead / Corresponding author)

Research output: Contribution to journalArticle

1 Citation (Scopus)
78 Downloads (Pure)

Abstract

Background: Bisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitation

Methods: Analysis of prospectively collected, linked routine clinical datasets. Participants were divided into never users of bisphosphonates, use prior to rehabilitation only, use after rehabilitation only, and current users (use before and after rehabilitation). We calculated change in 20-point Barthel scores during rehabilitation, adjusting for comorbid disease and laboratory data using multivariable regression analysis. Cox regression analyses were performed to analyse the association between bisphosphonate use and time to death or hospitalisation.

Results: 2797 patients were included in the analysis. Current bisphosphonate users showed greater improvement in Barthel score during rehabilitation than non-users (5.0 points [95%CI 4.3 to 5.7] vs 3.8 [95%CI 3.6 to 3.9]), but no difference compared to those receiving bisphosphonates only after discharge (5.1 [95%CI 4.6 to 5.5]). Previous bisphosphonate use was significantly associated with time to death (adjusted hazard ratio 1.41 [95%CI 1.15 to 1.73]) but less strongly with time to combined endpoint of hospitalisation or death (adjusted hazard ratio 1.18 [95%CI 0.98 to 1.48]). Use after discharge from rehabilitation was associated with reduced risk of death (adjusted hazard ratio 0.64 [95%CI 0.55 to 0.73]; hazard ratio per year of bisphosphonate prescription 0.98 [95%CI 0.97 to 0.99])

Conclusion: Bisphosphonate use is unlikely to be causally associated with improved physical function in older people, but continuing use may be associated with lower risk of death.
Original languageEnglish
Pages (from-to)195-200
Number of pages6
JournalArchives of Gerontology and Geriatrics
Volume70
Early online date11 Feb 2017
DOIs
Publication statusPublished - May 2017

Fingerprint

Diphosphonates
rehabilitation
death
Rehabilitation
hospitalization
Therapeutics
Hospitalization
Regression Analysis
regression analysis
medication
Disease
regression
Prescriptions
Inpatients
time
Bone and Bones
Muscles

Keywords

  • Older
  • Bisphosphonate
  • rehabilitation
  • resilience

Cite this

@article{34f2c12484374803b36fbc261645c1a4,
title = "Association between bisphosphonate therapy and outcomes from rehabilitation in older people",
abstract = "Background: Bisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitationMethods: Analysis of prospectively collected, linked routine clinical datasets. Participants were divided into never users of bisphosphonates, use prior to rehabilitation only, use after rehabilitation only, and current users (use before and after rehabilitation). We calculated change in 20-point Barthel scores during rehabilitation, adjusting for comorbid disease and laboratory data using multivariable regression analysis. Cox regression analyses were performed to analyse the association between bisphosphonate use and time to death or hospitalisation.Results: 2797 patients were included in the analysis. Current bisphosphonate users showed greater improvement in Barthel score during rehabilitation than non-users (5.0 points [95{\%}CI 4.3 to 5.7] vs 3.8 [95{\%}CI 3.6 to 3.9]), but no difference compared to those receiving bisphosphonates only after discharge (5.1 [95{\%}CI 4.6 to 5.5]). Previous bisphosphonate use was significantly associated with time to death (adjusted hazard ratio 1.41 [95{\%}CI 1.15 to 1.73]) but less strongly with time to combined endpoint of hospitalisation or death (adjusted hazard ratio 1.18 [95{\%}CI 0.98 to 1.48]). Use after discharge from rehabilitation was associated with reduced risk of death (adjusted hazard ratio 0.64 [95{\%}CI 0.55 to 0.73]; hazard ratio per year of bisphosphonate prescription 0.98 [95{\%}CI 0.97 to 0.99])Conclusion: Bisphosphonate use is unlikely to be causally associated with improved physical function in older people, but continuing use may be associated with lower risk of death.",
keywords = "Older, Bisphosphonate, rehabilitation, resilience",
author = "Goodbrand, {James A.} and Hughes, {Lloyd D.} and Lynda Cochrane and Peter Donnan and Mark McGilchrist and Helen Frost and Marion McMurdo and Miles Witham",
note = "Scottish Collaboration for Public Health Research and Policy, grant SCPH/10.",
year = "2017",
month = "5",
doi = "10.1016/j.archger.2017.01.017",
language = "English",
volume = "70",
pages = "195--200",
journal = "Archives of Gerontology and Geriatrics",
issn = "0167-4943",
publisher = "Elsevier",

}

Association between bisphosphonate therapy and outcomes from rehabilitation in older people. / Goodbrand, James A.; Hughes, Lloyd D. ; Cochrane, Lynda; Donnan, Peter; McGilchrist, Mark; Frost, Helen; McMurdo, Marion; Witham, Miles (Lead / Corresponding author).

In: Archives of Gerontology and Geriatrics, Vol. 70, 05.2017, p. 195-200.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between bisphosphonate therapy and outcomes from rehabilitation in older people

AU - Goodbrand, James A.

AU - Hughes, Lloyd D.

AU - Cochrane, Lynda

AU - Donnan, Peter

AU - McGilchrist, Mark

AU - Frost, Helen

AU - McMurdo, Marion

AU - Witham, Miles

N1 - Scottish Collaboration for Public Health Research and Policy, grant SCPH/10.

PY - 2017/5

Y1 - 2017/5

N2 - Background: Bisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitationMethods: Analysis of prospectively collected, linked routine clinical datasets. Participants were divided into never users of bisphosphonates, use prior to rehabilitation only, use after rehabilitation only, and current users (use before and after rehabilitation). We calculated change in 20-point Barthel scores during rehabilitation, adjusting for comorbid disease and laboratory data using multivariable regression analysis. Cox regression analyses were performed to analyse the association between bisphosphonate use and time to death or hospitalisation.Results: 2797 patients were included in the analysis. Current bisphosphonate users showed greater improvement in Barthel score during rehabilitation than non-users (5.0 points [95%CI 4.3 to 5.7] vs 3.8 [95%CI 3.6 to 3.9]), but no difference compared to those receiving bisphosphonates only after discharge (5.1 [95%CI 4.6 to 5.5]). Previous bisphosphonate use was significantly associated with time to death (adjusted hazard ratio 1.41 [95%CI 1.15 to 1.73]) but less strongly with time to combined endpoint of hospitalisation or death (adjusted hazard ratio 1.18 [95%CI 0.98 to 1.48]). Use after discharge from rehabilitation was associated with reduced risk of death (adjusted hazard ratio 0.64 [95%CI 0.55 to 0.73]; hazard ratio per year of bisphosphonate prescription 0.98 [95%CI 0.97 to 0.99])Conclusion: Bisphosphonate use is unlikely to be causally associated with improved physical function in older people, but continuing use may be associated with lower risk of death.

AB - Background: Bisphosphonate therapy may have actions beyond bone, including effects on cardiovascular, immune and muscle function. We tested whether bisphosphonate treatment is associated with improved outcomes in older people undergoing inpatient rehabilitationMethods: Analysis of prospectively collected, linked routine clinical datasets. Participants were divided into never users of bisphosphonates, use prior to rehabilitation only, use after rehabilitation only, and current users (use before and after rehabilitation). We calculated change in 20-point Barthel scores during rehabilitation, adjusting for comorbid disease and laboratory data using multivariable regression analysis. Cox regression analyses were performed to analyse the association between bisphosphonate use and time to death or hospitalisation.Results: 2797 patients were included in the analysis. Current bisphosphonate users showed greater improvement in Barthel score during rehabilitation than non-users (5.0 points [95%CI 4.3 to 5.7] vs 3.8 [95%CI 3.6 to 3.9]), but no difference compared to those receiving bisphosphonates only after discharge (5.1 [95%CI 4.6 to 5.5]). Previous bisphosphonate use was significantly associated with time to death (adjusted hazard ratio 1.41 [95%CI 1.15 to 1.73]) but less strongly with time to combined endpoint of hospitalisation or death (adjusted hazard ratio 1.18 [95%CI 0.98 to 1.48]). Use after discharge from rehabilitation was associated with reduced risk of death (adjusted hazard ratio 0.64 [95%CI 0.55 to 0.73]; hazard ratio per year of bisphosphonate prescription 0.98 [95%CI 0.97 to 0.99])Conclusion: Bisphosphonate use is unlikely to be causally associated with improved physical function in older people, but continuing use may be associated with lower risk of death.

KW - Older

KW - Bisphosphonate

KW - rehabilitation

KW - resilience

U2 - 10.1016/j.archger.2017.01.017

DO - 10.1016/j.archger.2017.01.017

M3 - Article

VL - 70

SP - 195

EP - 200

JO - Archives of Gerontology and Geriatrics

JF - Archives of Gerontology and Geriatrics

SN - 0167-4943

ER -