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Treatment of osteoporosis is not associated with increased longevity
Question clinique
Is the treatment of osteoporosis associated with increased longevity?
L’Essentiel
Osteoporosis treatment, even treatments with demonstrated hip fracture prevention, do not delay mortality. The head-scratching part of this analysis is that we have observational data that link fracture with early mortality and treatment with longevity. The latter may be due a healthy user bias, in which people who take medicines regularly are likely to engage in other healthy behaviors that help them live longer. 1a
Référence
Plan de l'etude: Meta-analysis (randomized controlled trials)
Financement: Unknown/not stated
Cadre: Various (meta-analysis)
Sommaire
The study was conducted using PRISMA guidelines. The authors searched 4 databases, including the Cochrane Library, to identify 38 randomized controlled studies of more than 100,000 patients that evaluated drug treatment of osteoporosis. The authors only included studies that lasted at least one year. Study quality was generally high. There was no evidence of publication bias. Heterogeneity was very low, except among studies of zoledronate. Overall, drug treatment was not associated with lower mortality. Analyzed separately, there was also no benefit found with bisphosphonates or zoledronate treatment for at least 3 years, although some single studies found a benefit. These randomized studies are in contrast to observational studies that show a benefit, though this benefit might be due to a healthy user effect, in which people who are adherent to treatment, even if that treatment is placebo, have better outcomes than those who are less adherent.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA