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03.01.2019 | Original Article | Ausgabe 4/2019

Osteoporosis International 4/2019

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

Zeitschrift:
Osteoporosis International > Ausgabe 4/2019
Autoren:
D. Bliuc, T. Tran, T. van Geel, J. D. Adachi, C. Berger, J. van den Bergh, J. A. Eisman, P. Geusens, D. Goltzman, D. A. Hanley, R. G. Josse, S. Kaiser, C. S. Kovacs, L. Langsetmo, J. C. Prior, T. V. Nguyen, J. R. Center, For the CaMOS Research Group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00198-018-4806-0) contains supplementary material, which is available to authorized users.

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Abstract

Summary

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.

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Zusatzmaterial
ESM 1 (DOCX 97 kb)
198_2018_4806_MOESM1_ESM.docx
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