Bisphosphonates and lower mortality risk: when it sounds to be good to be true …

Excerpt

Osteoporosis is a potentially lethal condition. Some of this excess mortality is attributable to the time-dependent increase in death that occurs in the aftermath of a fracture, particularly a hip fracture [1]. However, the factors that contribute to developing osteoporosis in the first place, including lifestyle (malnutrition, smoking, alcoholism) and medical comorbidities (too numerous to list) also increase mortality risk independent of any effect on fracture [2]. Indeed, mortality is highest in the first year after the fracture event and rapidly wanes with time, suggesting a decreasing proportion of deaths causally related to the fracture [3‐5]. This complex interplay between fracture and death is explicitly modeled in the fracture risk assessment tool (FRAX) [6]. Indeed, when fracture probability is estimated in the presence of competing mortality the exponential age-dependent increase in fracture risk is actually counteracted, reaching an inflection point around age 80 years, with a subsequent downturn [7]. …