Oral bisphosphonate use and mortality risk following major osteoporotic fracture

  • Abtahi S & al.
  • J Am Med Dir Assoc
  • 12 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Current oral bisphosphonates (BPs) use was associated with higher mortality risk after non-hip major osteoporotic fracture (MOF) and lower mortality risk after hip fracture.
  • The risk for mortality was reduced in patients with non-hip MOF and hip fracture with 1 and 5 years of follow-up and risk reduction was greater within the first year.

Why this matters

  • Future studies should evaluate the association between BPs use and mortality risk after fracture to explain alternative mechanisms of potential pleiotropic effects of BPs and potential unmeasured distortion.

Study design

  • Population-based cohort study included 163,273 patients with an MOF (aged ≥50 years) using the UK Clinical Practice Research Datalink (CPRD).
  • Risk of all-cause mortality was compared between current (0-6 months), recent (7-12 months) and past (>1 year) BPs use after non-hip MOF and hip fracture.
  • Funding: None.

Key results

  • Of 163,273 patients, 119,107 (72.9%) had non-hip MOF and 44,166 (27.1%) had hip fractures.
  • Current BP use vs no use was associated with higher all-cause mortality risk in non-hip MOF (adjusted HR [aHR], 1.07; 95% CI, 1.03-1.10) and lower all-cause mortality risk in hip fracture group (aHR, 0.72; 95% CI, 0.70-0.75).
  • Past BP use vs no use was associated with lower risk for all-cause mortality in non-hip MOF (aHR, 0.86; 95% CI, 0.83-0.90) and hip fracture (aHR, 0.58; 95% CI, 0.55-0.62) group.
  • During 5-year analysis, current BP use vs no use was linked to lower mortality risk after non-hip MOF (aHR, 0.91; 95% CI, 0.87-0.95) and hip fracture (aHR, 0.61; 95% CI, 0.59-0.64).
  • During the 1-year analysis, risk reduction was greater in non-hip MOF (aHR, 0.66; 95% CI, 0.60-0.72) and hip fracture (aHR, 0.41; 95% CI, 0.37-0.44) group with current BP use.
  • Women vs men were at lower risk for all-cause mortality.

Limitations

  • Study did not exclude participants who died shortly after having a fracture.