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BALANCING THE BENEFITS OF BISPHOSPHONATE TREATMENT WITH RISK OF ADVERSE EVENTS IN FRAIL NURSING HOME RESIDENTS

Analytic decisions can profoundly impact observational study results. Little data exist about the influence of these decisions when estimating effects of osteoporosis medica-tions in older adults. We evaluated the effects of first-line osteoporosis treatment, bisphosphonates, versus calcitonin on hip fractures and esophagitis among NH residents using several approaches to address biases. Approaches included propensity score matching, inverse probability of treatment weighting (IPW), multiple imputation (MI), machine learn-ing, and Fine and Gray competing risk regressions. Results did not vary markedly by method for hip fractures, but did for esophagitis. Hazard ratios for hip fracture ranged from 0.86 [95% CI, 0.71–0.91] for MI plus IPW to 0.89 (CI, 0.75–1.05) for Fine and Gray models. Esophagitis estimates ranged from 0.95 (CI, 0.78–1.17) for MI plus IPW to 1.19 (CI, 0.90–1.58) for Fine and Gray models. Investigators stud-ying medication effects in observational studies should use several complementary analytic methods and should present all results.