Association Between Bisphosphonates and Hospitalized Clostridioides difficile Infection Among Frail Older Adults.
Document Type
Article
Publication Date
1-10-2020
Institution/Department
Center for Outcomes Research and Evaluation; Maine Medical Center Research Institute
Journal Title
Journal of the American Medical Directors Association
MeSH Headings
Aged, Frail Elderly, Diphosphonates, Clostridium Infections
Abstract
OBJECTIVES: Clostridioides difficile infection is a major source of morbidity and mortality among frail older adults, especially those in nursing homes (NHs). Safety reports have signaled that bisphosphonate use may be a contributing cause. We therefore evaluated the risk of C difficile hospitalization associated with oral bisphosphonate use in the NH.
DESIGN: Observational, retrospective new-user cohort study.
SETTING: The cohort included US NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH) between January 1, 2008 and December 31, 2009.
METHODS: We conducted a study of NH residents using linked Medicare claims and Minimum Data Set records. Residents were new users of an oral bisphosphonate 1:1 matched to new calcitonin users ("active" comparator) on propensity scores controlling for more than 100 covariates. The outcome was risk of hospitalization for C difficile infection in a Cox proportional hazards model adjusted for previous antibiotic and proton pump inhibitor use.
RESULTS: Our final analytical cohort included 17,753 bisphosphonate and 5348 calcitonin users. In the matched cohort, 84/5209 (1.6%) vs 71/5209 (1.4%) C difficile-related hospitalizations occurred in bisphosphonate and calcitonin users, respectively. We observed no significant difference in the risk of hospitalization among bisphosphonate users (hazard ratio: 1.11, 95% confidence interval: 0.80-1.51). Antibiotic and proton pump inhibitor exposure before and after osteoporosis treatment was also similar between bisphosphonate and calcitonin users.
CONCLUSIONS AND IMPLICATIONS: C difficile infection should not be a consideration when prescribing bisphosphonates to frail older adults given the lack of a significant association.
ISSN
1538-9375
Recommended Citation
McConeghy, Kevin W; Zullo, Andrew R; Lary, Christine W; Zhang, Tingting; Lee, Yoojin; Daiello, Lori; Kiel, Douglas P; and Berry, Sarah, "Association Between Bisphosphonates and Hospitalized Clostridioides difficile Infection Among Frail Older Adults." (2020). MaineHealth Maine Medical Center. 1542.
https://knowledgeconnection.mainehealth.org/mmc/1542