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.
Keywords
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Article info
Publication history
Published online: January 13, 2020
Footnotes
This work was supported by the National Institute of Health, National Institute on Aging (grant nos. R101AG045441 and 5P01AG027296-05).
S.B. received a research grant from Amgen to study bone mineral density change in persons receiving treatment for osteoporosis.
This work was submitted in part as an abstract to be presented at the 2018 annual conference for the Gerontological Society of America in Boston, MA.
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
