Oral bisphosphonates are associated with reduced mortality after hip fracture

Beaupré, Lauren A; Morrish, Donald W.; Hanley, David A.; Maksymowych, Walter P.; Bell, Neil R.; Juby, Angela; Majumdar, Sumit R.

doi:10.1007/s00198-010-1411-2

Cited by 147 publications

(95 citation statements)

References 26 publications

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“…In fact, men are twice as likely to die following a hip fracture as women [10]. Beyond the obvious fracture-related benefits, three recent studies (two of which examined oral bisphos phonates) and a systematic review of randomized trials [34] have also demonstrated that mortality is reduced in those exposed to bisphosphonates even after controlling for age, comorbidity, and fracture incidence [35][36][37]. One of these studies was a longitudinal cohort of 2005 elderly LTC residents that reported oral bisphosphonate exposure was associated with a significantly reduced hazard for mortality [hazard ratio=0.73; 95% confidence interval (CI) 0.56,0.94] [37].…”

Section: Discussionmentioning

confidence: 95%

Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions

et al. 2011

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Rates of pre-admission bisphosphonate treatment were low, but did double after LTC admission. Women were almost ten times more likely to start bisphosphonate treatment than men, although one fifth of those with documented osteoporosis were men. Although falls cause most fractures, a history of falls with injury was not associated with bisphosphonate treatment. Our findings suggest that targeting men and residents with falls for treatment with bisphosphonates might be warranted.

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Section: Discussionmentioning

confidence: 95%

Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions

et al. 2011

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“…Lyles et al showed that intravenous bisphosphonate treatment in form of zoledronic acid reduced mortality after surgical hip fracture repair [38], while Beaupre et al showed that oral bisphosphonate treatment with alendronate and risedronate reduced all-cause mortality in this population [39]. Despite these findings, the majority of patients with hip fractures are only surgically treated, with little attention being paid to osteoporosis.…”

Section: Biochemical Parametersmentioning

confidence: 97%

Advanced Age, High β-CTX Levels, and Impaired Renal Function are Independent Risk Factors for All-Cause One-Year Mortality in Hip Fracture Patients

et al. 2015

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Risk factors for increased mortality in hip fracture patients include older age, male sex, fracture type, bone mineral density, and pre-existing co-morbidities. The role of biochemical and other anthropometric parameters on hip fracture mortality remains unclear. The aim of this study was to identify the risk factors for one-year mortality in patients with hip fractures. A total of 236 consecutive patients (59 males) with hip fractures were followed over a one-year period. Patient age, gender, type of fracture, type of treatment, time from admission to surgery, type of anesthesia, body mass index, and electrocardiograms were recorded. Complete blood counts, serum electrolytes, urea, creatinine, d-dimers, calcium, phosphate, osteocalcin, and beta-isomerised C-terminal telopeptide of collagen type I (β-CTX) were measured at admission and estimated glomerular filtration rate (eGFR) was calculated. Multivariate Cox regression models were used to analyze the association of these parameters with survival. One-year mortality rate was 28.4%. Age was independently associated with mortality (HR 1.117, 95% CI 1.062-1.174, P < 0.001). In a multivariable model, mortality was increased in patients with higher β-CTX (HR 4.63 95% CI 1.87-11.45, P = 0.001) and lower eGFR (HR 0.972, 95% CI 0.956-0.987, P < 0.001). Patients younger than 84 years, with eGFR < 55.4 ml/min had ten times higher mortality rates (3.2 vs. 24.5%, HR 9.73, 95% CI 2.06-45.93) as well as those with β-CTX > 0.276 g/L (3.5 vs. 25.7%, HR 9.5, 95% CI 2.11-42.76). Advanced age, high β-CTX levels, and impaired renal function are independent risk factors of mortality in patients with hip fractures.

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“…(7) In a Canadian randomized 3-year follow-up study, hip fracture patients with oral bisphosphonate use had a lower mortality than those receiving no treatment (7% versus 16%). (8) Each year of treatment was associated with a 63% relative reduction in the risk of death. (8) Another Australian 5-year followup study among institutionalized hip fracture patients showed that the use of oral bisphosphonates was associated with a 27% reduction in the risk of death compared with nonusers.…”

Section: J Jbmrmentioning

confidence: 99%

“…(8) Each year of treatment was associated with a 63% relative reduction in the risk of death. (8) Another Australian 5-year followup study among institutionalized hip fracture patients showed that the use of oral bisphosphonates was associated with a 27% reduction in the risk of death compared with nonusers. (9) In a recent meta-analysis by Bolland and colleagues (10) on the effect of osteoporosis treatment on mortality, eight studies of four drugs (ie, risedronate, strontium ranelate, zoledronic acid, and denosumab) were included in the primary analysis and two alendronate studies in the secondary analysis.…”

Section: J Jbmrmentioning

confidence: 99%

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

Nurmi-Lüthje

Sund

Juntunen

et al. 2011

Journal of Bone and Mineral Research

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We previously found a positive association between calcium plus vitamin D and antiosteoporotic drugs and survival among hip fracture patients. Our aim was to verify this observation using a nationwide database. A retrospective cohort of home-discharged hip fracture patients aged 50 years or older (n ¼ 23,615) was enrolled from the national database. Primary exposure was medical treatment for osteoporosis, and the outcome was all-cause mortality. Cumulative mortalities were calculated using the Kaplan-Meier estimator. The relationship between mortality and medication purchases was modeled using Cox's proportional hazards regression with timedependent covariates for medication use. One in 4 women and 1 in 10 men with a hip fracture were treated for osteoporosis in Finland. Unadjusted 1-year mortality was lower among patients who purchased calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs than among those who did not purchase these medications [hazard ratio (HR) ¼ 0.74, 95% confidence interval (CI) 0.67-0.81]. The difference in unadjusted cumulative mortality remained in favor of the drug users for at least 5 years. Among men, the use of calcium plus vitamin D or vitamin D supplements was associated with lower 1-year mortality even after adjustments for observed confounders (HR ¼ 0.74, 95% CI 0.56-0.97). Among women, the use of antiosteoporotic drugs was associated with lower mortality (HR ¼ 0.79, 95% CI 0.67-0.93). There was a tendency to even better survival in both genders if calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs were used simultaneously, the HR being 0.72 (95% CI 0.50-1.03) in men and 0.62 (95% CI 0.50-0.76) in women. ß

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Oral bisphosphonates are associated with reduced mortality after hip fracture

Abstract: Like intravenous bisphosphonates after hip fracture, our study suggests that oral bisphosphonates may be associated with reductions in all-cause mortality.

Cited by 147 publications

References 26 publications

Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions

Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions

Advanced Age, High β-CTX Levels, and Impaired Renal Function are Independent Risk Factors for All-Cause One-Year Mortality in Hip Fracture Patients

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

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