Alendronate With Glucocorticoids Lowers Nonvertebral Fracture Risk

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Alendronate users had a longer median follow-up than did nonusers (17.0 vs 12.2 months).
Alendronate users had a longer median follow-up than did nonusers (17.0 vs 12.2 months).

Older adults taking alendronate and oral glucocorticoids are at a lower risk for nonvertebral fracture, including hip fracture, according to a retrospective cohort study published in the Journal of Endocrinology & Metabolism.1

Researchers used national Swedish registers from hospitals and ambulatory specialist care practices to identify 16,890 patients taking alendronate and matched them with 16,890 nonusers.1 Inclusion criteria included patients who were 50 years of age or older and were receiving an oral glucocorticoid therapy of at least 2.5 mg/day of prednisone or equivalent for 91 or more days. The mean age of the patients was 72 years, and the median average glucocorticoid dose at baseline was 17.2 mg/day of prednisone (or equivalent), which decreased to 8.6 mg/day by the end of follow-up.

Glucocorticoids are often administered with osteoporosis medications, most commonly alendronate, to prevent fractures.2 At a median follow-up of 14.5 months, the present study showed that this combination is associated with 16% fewer nonvertebral fractures compared with nonusers, and that this association was strongest in patients receiving high doses of glucorticoids.1 In addition, patients taking alendronate experienced 34% fewer hip fractures compared with nonusers, all of whom received concomitant glucocorticoid therapy.

It is important to note that the results of this observational trial may be caused by confounding resulting from a lack of data on smoking, bone mineral density, and the indication for glucocorticoid therapy.1 However, similar results have been found in meta-analyses demonstrating the effect of alendronate in patients receiving glucocorticoids.3-7 Therefore, the investigators concluded, "this study showed that alendronate use was associated with a lower risk of nonvertebral fracture, including a lower risk of hip fracture."1

References

  1. Bergman J, Nordström A, Nordström P. Alendronate use and the risk of nonvertebral fracture during glucocorticoid therapy: a retrospective cohort study [published online November 3, 2017]. J Clin Endocrinol Metab. doi: 10.1210/jc.2017-01912
  2. Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.
  3. Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M. Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Heal Technol Assess. 2007;11:iii-iv.
  4. Allen CS, Yeung JHS, Vandermeer B, Homik J. Bisphosphonates for steroid-induced osteoporosis. Cochrane Database Syst Rev. 2016;10:CD001347.
  5. Cranney A, Wells G, Willan A, et al.; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev. 2002;23:508-516.
  6. Boonen S, Laan RF, Barton IP, Watts NB. Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies. Osteoporos Int. 2005;16:1291-1298.
  7. Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008;1:CD001155.
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