To the Editor Dr Axelsson and colleagues1 evaluated the association between alendronate use and risk of hip fracture among older adults taking prednisolone. Although the availability of a large population-based cohort is a major strength, their study design comparing prevalent alendronate users with nonusers raises several concerns.
First, treated patients were required to have at least 3 months of alendronate use and evidence of current use at the start of follow-up for outcomes. Therefore, alendronate users who experienced safety events early in the treatment course and discontinued treatment because of the adverse event would not have been eligible for inclusion in this study. This could have resulted in underestimation of safety events due to depletion of susceptible patients from the treatment group.2,3
Desai RJ, Franklin JM, Kim SC. Alendronate and Hip Fracture in Patients Using Glucocorticoids. JAMA. 2017;318(17):1711–1712. doi:10.1001/jama.2017.14291
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