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Osteoporos Int. 2019 Jan 3. doi: 10.1007/s00198-018-4806-0. [Epub ahead of print]

Mortality risk reduction differs according to bisphosphonate class: a 15-year observational study.

Author information

1
Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia. d.bliuc@garvan.org.au.
2
Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
3
Maastricht University Medical Center, Research School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands.
4
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
5
CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada.
6
Research School Nutrim, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
7
Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands.
8
School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.
9
Biomedical Research Institute, University Hasselt, Hasselt, Belgium.
10
Department of Medicine, McGill University, Montreal, Quebec, Canada.
11
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
12
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
13
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
14
Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada.
15
School of Public Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA.
16
Department of Medicine and Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada.
17
Clinical School, Faculty of Medicine, St Vincent's Hospital, UNSW, Sydney, Australia.
18
School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia.

Abstract

In this prospective cohort of 6120 participants aged 50+, nitrogen-bisphosphonates but not non-nitrogen bisphosphonates were associated with a significant 34% mortality risk reduction compared to non-treated propensity score matched controls. These findings open new avenues for research into mechanistic pathways.

INTRODUCTION:

Emerging evidence suggests that bisphosphonates (BP), first-line treatment of osteoporosis, are associated with reduced risks for all-cause mortality. This study aimed to determine the association between different BP types and mortality risk in participants with or without a fracture.

METHODS:

A prospective cohort study of users of different BPs matched to non-users by propensity score (age, gender, co-morbidities, fragility fracture status) and time to starting the BP medication from the population-based Canadian Multicentre Osteoporosis Study from nine Canadian centres followed from 1995 to 2013. Mortality risk for bisphosphonate users vs matched non-users was assessed using pairwise multivariable Cox proportional hazards models.

RESULTS:

There were 2048 women and 308 men on BP and 1970 women and 1794 men who did not receive medication for osteoporosis. The relationship between BP and mortality risk was explored in three separate 1:1 propensity score-matched cohorts of BP users and no treatment (etidronate, n = 599, alendronate, n = 498, and risedronate n = 213). Nitrogen BP (n-BP) (alendronate and risedronate) was associated with lower mortality risks [pairwise HR, 0.66 (95% CI, 0.48-0.91)] while the less potent non-n-BP, etidronate, was not [pairwise HR: 0.89 (95% CI, 0.66-1.20)]. A direct comparison between n-BP and etidronate (n = 340 pairs) also suggested a better survival for n-BP [paired HR, 0.47 (95%CI, (95% CI, 031-0.70)] for n-BP vs. etidronate].

CONCLUSION:

Compared to no treatment, nitrogen but not non-nitrogen bisphosphonates appear to be associated with better survival.

KEYWORDS:

Bisphosphonate; Fracture; Mortality risk; Osteoporosis; Prospective study

PMID:
30607457
DOI:
10.1007/s00198-018-4806-0

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