Mortality and morbidity associated with osteoporosis drug treatment following hip fracture

Abstract

This study examined post-fracture osteoporosis drug treatment in hip fracture patients and the association of treatment with mortality and morbidity. Pre- and post-fracture demographic/health information was collected on a cohort of hip fracture patients aged 65+ years. Post-fracture administrative data on prescription drug use and health care utilization was linked to the cohort data. Five classes of osteoporosis drugs were available during the study period: hormone replacement therapy (HRT), bisphosphonates (BSP), calcitonin, selective estrogen receptor modulators (SERMs) and vitamin D(3) (Rocaltrol). Pre-fracture, 38 of 449 patients (8%) were on osteoporosis medications. Post-fracture, 81 of 356 patients (23%) were treated; 63 of these patients were untreated prior to fracture. Both treated and untreated patients had similar rates of subsequent hip fracture (6% and 4%, respectively) and Colles fracture (2%). Regardless of treatment status, patients were also equally likely to be hospitalized, both in the short-term (28% in treated, 27% in untreated) and in the long-term (43% versus 37%). However, mortality was significantly lower in the treated group. The lower mortality in the treated group, combined with the knowledge that antiresorptive drugs reduce fractures and increase bone density, merit undertaking a randomized trial to confirm our findings that antiresorptive therapy should be considered in all patients post-hip fracture.

Oral bisphosphonates are associated with reduced mortality after hip fracture

“…Furthermore, although our study examined only the impact of oral bisphosphonates, it confirms and extends the results of the only two non-randomized studies that have tried to examine the relationship between mortality and osteoporosis treatments (that collectively included oral bisphosphonates, estrogen therapy, selective estrogen receptor modifiers, and calcium and Vitamin D supplementation) following hip fracture while overcoming several of their collective limitations [7,9]. The first study by Cree et al examined any post-hip fracture osteoporosis treatment and subsequent mortality in a study of 449 Canadian patients from 1997 to 2001 [7]. In adjusted analyses, any prescribed osteoporosis treatment was associated with reduced mortality over 4 years follow-up (treated patients who died (n=14 [17%]) vs. untreated patients who died (n=158 [44%]); adjusted HR 0.34, 95% CI 0.17, 0.70).…”

“…The increased morbidity and mortality extends well beyond the time of convalescence [1][2][3] and includes an increased risk for repeat hip fracture [4,5]. Furthermore, low bone mass is common, though not universal, in hip fracture patients, and osteoporosis is under-diagnosed and undertreated [6][7][8][9]. Treatment with the intravenous bisphosphonate zoledronic acid reduces rates of re-fracture and all-cause mortality in patients with hip fractures [10].…”

“…To our knowledge, only two observational studies of the question exist, and both suggest a significant mortality benefit with "any" osteoporosis treatment [7,9]. In addition, a recent meta-analysis examined the impact of bisphosphonate treatment following any fracture and again, suggested a mortality benefit with treatment [13].…”

Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey

“…Therefore, current national and international guidelines recommend the use of pharmacological treatments after hip fracture [10,11]. Moreover, the results of several studies showed a decreased mortality rate in patients who were managed with antiosteoporotic drugs as compared with those who were not [12][13][14]. In particular, in the HORIZON study [13] hip fracture patients were randomly assigned to receive annually zoledronic acid either by intravenous infusion or a placebo infusion; both groups received both oral calcium and vitamin D daily.…”

Post–hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs is associated with lower mortality: A nationwide study in Finland

“…A Canadian study showed a significant decrease in the mortality of patients treated with antiosteoporotic drugs versus nontreated patients. (5) In a recent international large-scale, randomized, controlled multicenter trial in which hip fracture patients were randomly assigned to receive annual either zoledronic acid by intravenous infusion or a placebo infusion, the secondary endpoint was allcause mortality. (6) Both groups received daily oral calcium and vitamin D. The median follow-up was 1.9 years.…”