Oral Bisphosphonates Lowered Mortality, Subsequent Fracture Risks

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Bisphosphonates may be beneficial as secondary prevention after fracture.
Bisphosphonates may be beneficial as secondary prevention after fracture.

SEATTLE — Oral bisphosphonate therapy as secondary prevention appears to significantly lower the risk for subsequent fractures as well as mortality rates in patients following an initial fracture, according to recently presented data.

“After a fracture, men and women had fewer subsequent fractures and importantly survive longer-term if they were treated with oral bisphosphonates,” said study investigator Tineke Van Geel, PhD, who is a research scientist at Maastricht University in the Netherlands. “This may be the first study to show this in a large follow-up study.”

Dr Van Geel, who presented the study findings at the American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting, said there has been controversy surrounding the potential risks and benefits of oral bisphosphonate therapy following an osteoporotic fracture.

To further investigate this issue, she and colleagues analyzed the effect of oral bisphosphonate therapy on subsequent fracture and mortality over a period of 8 years. The study included 5011 men and women who experienced a fracture between 1999 and 2007. All the patients were older than 50 years of age and had suffered a clinical fracture.

All patients received calcium and vitamin D. However, 50.7% of the patients (n= 2534) were prescribed oral bisphosphonates, according to specific predetermined criteria.

Absolute subsequent fracture risk after 8 years of follow up for those men and women who were prescribed bisphosphonates was 13.3% compared with 11.8% for those who received calcium and vitamin D only, according to the researchers.

In addition, they found that absolute mortality risk was 15.0% for those receiving oral bisphosphonates vs 9.5% for those who received vitamin D and calcium supplementation only.  

In this study, individuals who were prescribed bisphosphonates were more likely to be female (82.9% vs 72.4%), older (73.4 vs 64.4 years), and have lower bone mineral density (BMD; T-score: –3.1 vs –1.5). They also had experienced more hip fractures than those individuals who received vitamin D and calcium supplementation only (21.7% vs 6.2%).

When the two groups were analyzed separately, results indicated age, gender, BMD, and fracture location as well as high alcohol intake, glucocorticoid use, and smoking were predictors of fracture and mortality.

After adjusting for these characteristics, the patients who were prescribed bisphosphonates had substantially lower risks for subsequent fragility fracture (HR=0.59; 95% CI, 0.48-0.73) and mortality (HR=0.79; 95% CI, 0.64-0.96).  

“These long-term community-based data indicate a clear benefit of oral bisphosphonate therapy for both subsequent fracture and mortality outcomes,” Dr Van Geel told Endocrinology Advisor.

Several studies presented at this meeting suggested that many patients who could benefit from bisphosphonate therapy are not receiving it. Research indicates that much greater efforts are needed to improve awareness of the benefits of fracture prevention therapy among patients as well as clinicians.

“The simple message is that even after a fragility fracture, worldwide, only a minority of people get antiresorptive treatment. In part, this is because of concern about the risk–benefit balance,” said study investigator professor John Eisman, MBBS, who is with the Garvan Institute of Medical Research in Sydney, Australia, told Endocrinology Advisor

“Our study shows that people treated with oral bisphosphonates have fewer subsequent fractures and importantly survive longer-term. These quality-of-life and survival benefits would seem to easily outweigh any concerns about the very low risk of adverse effects of these treatments." 

Reference

  1. Van Geel T. Reduced Mortality and Subsequent Fracture Risk with Oral Bisphosphonate Treatment in Secondary Fracture Prevention: an Observational 8-Year Follow-Up Study. Presented at: American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting; Oct. 9-12, 2015; Seattle.
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