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Reduced all-cause mortality associated with post-fracture bisphosphonate treatment
Clinical Question
Is the treatment of osteoporosis with bisphosphonates in patients who have experienced a fracture effective in prolonging their lives?
Bottom line
This very large observational study found a mortality benefit to treating patients with a bisphosphonate following a major fracture. However, a 2020 meta-analysis did not. The imbalance of risk factors in this study (see the synopsis) may be part of the explanation, as well as the healthy user bias, in which people who take medicines regularly are likely to engage in other healthy behaviors that help them live longer. 2b
Reference
Study design: Cohort (retrospective)
Funding: Government
Setting: Outpatient (any)
Synopsis
Using the Taiwan National Health Insurance database, these researchers identified 101,115 patients with a diagnosis of osteoporosis and who had been hospitalized for a major fracture and followed them up over a 10-year period. This national database captures data for 99.6% of the population. This was not a randomized trial and patient characteristics were significantly different in every single demographic category. Among the study population, treatment with a bisphosphonate, mostly with alendronate or risedronate (74.6%) was started in 24,390 women and men. Patients who received bisphosphonate treatment were more likely to be female (74.3%), were older, and were more likely to have a hip or vertebral fracture. In other words, bisphosphonate users had a higher risk for mortality. The investigators controlled for these variables and then analyzed results by duration of treatment, type of fracture, and type of treatment. Overall, in the first 3 years of treatment, bisphosphonate treatment was not associated with a change in mortality; however, patients with hip fracture received a small benefit after at least 1 year of treatment [hazard ratio (HR) 0.91; 95% CI 0.87 - 0.95). After 3 years, lower mortality rates were associated with treatment in patients with major fracture (HR 0.60; 0.52 - 0.67). Similar benefit was seen with alendronate/risedronate or with zoledronic acid.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Bias inherent in clinical research using an observational de
A good example for us to remember
Bisphosphonates with fractures and life span
Large but heterogeneous group makes it hard to ascribe even the small difference. Not a proper randomized double blind study.
Mortality benefits of Biphosphonates post-fracture
Based on the reviewer's comments there seems to be some consistency with observational studies (including the one reviewed here) showing a mortality benefit and the recent meta-analysis based on RCTs which was mentioned by the review which did not show a mortality benefit. Which am I to believe? For now will stick with outcomes from the RCTs.
mortality and biphosphonates
Useless info.
BISPHOSPONATE USE POST MAJOR FRACTURE
MAY DECREASE FUTURE MORTALITY