Antiosteoporosis agents help prevent postfracture death

Use of antiosteoporotic medication, particularly a long-acting regimen, appears to reduce postfracture mortality, according to a population-based study.

A team of investigators conducted a longitudinal, population-based, postfracture cohort study using mega-data from individuals aged ≥40 years with osteoporotic fracture who used antiosteoporotic medications as recorded in Taiwan’s National Health Insurance Research Database from 2009 to 2017 and followed until 2018.

The association between fracture sites and mortality was explored using a multivariate Cox proportional hazards model with immortal time bias, stratified by antiosteoporosis medication.

The investigators enrolled 46,729 individuals with a mean age of 74.45 years (80.0 percent female) and a mean follow-up of 4.73 years.

In individuals with total fracture, treatment with alendronate/risedronate (hazard ratio [HR] 0.83, 95 percent confidence interval [CI], 0.79‒0.88), denosumab (HR, 0.86, 95 percent CI, 0.81‒0.91), and zoledronic acid (HR, 0.78, 95 percent CI, 0.73‒0.84) led to a significant decrease in mortality compared with raloxifene and bazedoxifene therapy.

Similar findings were noted in those with hip, vertebral, or nonhip/nonvertebral fractures.

In a subanalysis according to sex or age >65 years, participants treated with long-acting zoledronic acid were found to have the lowest mortality.

“Osteoporosis is becoming a global epidemic in ageing societies,” the investigators said. “Antiosteoporotic medications can prevent fractures, and their pleiotropic effect on mortality is interesting but not well compared among each other.”