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<i>Summary</i> <p>In the U.S’s largest integrated health system, during a 24-year period (1999–2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty.</p> Purpose <p>To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.</p> Methods <p>U.S. national Veterans Health Administration (VHA) data (1999–2022) were queried to identify men aged ≥ 50&#xa0;years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65&#xa0;years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.</p> Results <p>A total of 298,340 men initiated a BP during 1999–2022, of whom 233,857 (78.4%) were aged ≥ 65&#xa0;years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004–2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged &lt; 65&#xa0;years declined from a peak of 28.2% during the middle time period (2008–2012) to a nadir of 13.3% during the final years (2018–2022, <i>p</i> &lt; 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999–2002 to 24.5% in 2018–2022 (<i>p</i> &lt; 0.001). Notably, over half of the men who initiated BP during 1999–2002 were classified as non-frail, whereas in the most recent time period (2018–2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (<i>p</i> &lt; 0.001).</p> Conclusion <p>In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.</p>

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Shifting bisphosphonate prescribing patterns for fracture prevention: a 24-year national surveillance of men in the U.S. Veterans Health Administration

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  • 发表日期：

    2026年1月8日

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  • Rachel E. Elam,
  • Joan C. Lo,
  • John T. Schousboe,
  • Robert A. Adler,
  • Howard A. Fink,
  • Susan M. Ott,
  • Joshua Barzilay,
  • Frances M. Weaver,
  • Emily Budde,
  • Zhiping Huo,
  • Reside Jacob,
  • Laura D. Carbone

摘要

Summary

In the U.S’s largest integrated health system, during a 24-year period (1999–2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty.

Purpose

To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.

Methods

U.S. national Veterans Health Administration (VHA) data (1999–2022) were queried to identify men aged ≥ 50 years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65 years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.

Results

A total of 298,340 men initiated a BP during 1999–2022, of whom 233,857 (78.4%) were aged ≥ 65 years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004–2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged < 65 years declined from a peak of 28.2% during the middle time period (2008–2012) to a nadir of 13.3% during the final years (2018–2022, p < 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999–2002 to 24.5% in 2018–2022 (p < 0.001). Notably, over half of the men who initiated BP during 1999–2002 were classified as non-frail, whereas in the most recent time period (2018–2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (p < 0.001).

Conclusion

In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.