The association between osteoporosis medications and lowered all-cause mortality after hip or vertebral fracture in older and oldest-old adults: a nationwide population-based study

Abstract

Background: Osteoporotic fracture is a common public-health problem in ageing societies. Although postfracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old). Methods: Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018. Results: A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture). Conclusions: Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.

Association between pharmacotherapy and secondary vertebral fracture managed with a brace in a real‐world setting: A nationwide database study in Japan

“…7 Osteoporosis treatment after VF onset is effective in preventing subsequent VFs and reducing mortality rates. 8 Therefore, osteoporosis diagnosis and pharmacotherapy initiation after VF is important. [9][10][11] However, only 61.7% of patients receive osteoporosis treatment within 1 year after VF registration according to the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB Japan).…”

“…Patients with VFs have a high imminent fracture risk 7 . Osteoporosis treatment after VF onset is effective in preventing subsequent VFs and reducing mortality rates 8 . Therefore, osteoporosis diagnosis and pharmacotherapy initiation after VF is important 9–11 .…”