Objective:

To assess the incidence of long-term discontinuation (LTD) of osteoporosis therapy in postmenopausal women and its effects on fracture risk and health care resource utilization.

Approach:

• Study Design: A retrospective nationwide cohort study using data from the French Système National de Données de Santé (SNDS) covering over 99% of the national population.
• Patient Selection: Women aged ≥60 years with postmenopausal osteoporosis who initiated treatment with oral or intravenous bisphosphonates or denosumab between January 1, 2012, and December 31, 2015.
• Data Collection: Utilized electronic health records to determine treatment exposure, adherence, and long-term discontinuation.
• Propensity Score Matching: Matched women experiencing LTD with those without LTD based on propensity scores to control for confounding variables.

Key Findings:

• The study identified the frequency of long-term discontinuation of osteoporosis therapy among postmenopausal women.
• Differences in fragility fracture risk between bisphosphonates and denosumab were highlighted.
• Compliance concerns were noted, indicating that adherence to therapy is critical for fracture risk management.

Interpretation:

The findings suggest that long-term discontinuation of osteoporosis therapy is prevalent among postmenopausal women, which may lead to an increased risk of fragility fractures. The comparative analysis of bisphosphonates and denosumab indicates that different treatment modalities may have varying impacts on fracture risk, emphasizing the need for personalized treatment approaches. Furthermore, the study underscores the importance of monitoring adherence to osteoporosis therapy, as non-compliance can significantly affect patient outcomes.

Limitations:

• The study is retrospective and relies on existing health records, which may have limitations in data completeness.
• Potential confounding factors may not be fully accounted for despite propensity score matching.
• The reliance on health records raises concerns about the accuracy of reported adherence and discontinuation rates.

Conclusion:

In conclusion, the long-term cessation of osteoporosis therapy in postmenopausal women is associated with an increased risk of fractures. This highlights the necessity for ongoing patient education and support to improve adherence to osteoporosis treatment, ultimately aiming to reduce fracture incidence and enhance patient quality of life. Future research should focus on strategies to maintain treatment adherence and evaluate the long-term outcomes of different osteoporosis therapies.