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Bisphosphonate treatment is associated with decreased mortality rates in patients after osteoporotic vertebral fracture

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Abstract

Summary

The aim of this study is to investigate the effect of bisphosphonate (BP) on mortality after osteoporotic vertebral fracture (OVF). BP medication (hazard ratios = 0.593; 95%CI: 0.361–0.976) was significantly associated with reduced all-cause mortality after OVF.

Purpose

Osteoporotic vertebral fracture (OVF) is the most common type of fragility fracture. Bisphosphonate (BP) medication was suggested to have positive effects on both fracture prevention and recovery outcomes. The aim of this study is to investigate the effect of BP on mortality after OVF.

Methods

This cohort study involved 535 patients (170 males and 365 females), aged ≥ 65 years (mean age: 82.6 ± 7.0 years, mean follow-up periods: 33.0 ± 25.8 months) who were hospitalized after OVF from January 2011 to December 2019 at a public hospital. Patients treated with PTH (parathyroid hormone), PTH or PTHrp analogues, denosumab, and selective estrogen receptor modulators were excluded. Kaplan–Meier survival curves on mortality of patients with OVF with and without BP treatment were prepared, and log-rank tests were performed. Cox proportional hazards model was used to identify factors associated with mortality after OVF.

Results

This study included 163 (30.5%) patients treated with BP. Kaplan–Meier survival curves showed that the mortality rate after OVF was significantly lower in patients treated with BP (P < 0.001). Cox proportional hazards model showed that older age (hazard ratios [HR] = 1.066; 95%CI:1.035–1.103), male sex (HR = 2.248; 95%CI:1.427–3.542), malnutrition (geriatric nutritional risk index < 92) (HR = 1.691; 95%CI:1.005–2.846), BP medication (HR = 0.593; 95%CI: 0.361–0.976), and Japanese Orthopaedic Association score at discharge (HR = 0.941; 95%CI: 0.892–0.993) were significantly associated with all-cause mortality after OVF.

Conclusions

BP medication is beneficial not only for fracture prevention but also for mortality after OVF.

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Availability of data and materials

The datasets used for analysis in the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Hiroki Iida, Taisuke Seki & Shiro Imagama

  2. Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan

    Yoshihito Sakai, Tsuyoshi Watanabe, Norimitsu Wakao & Hiroki Matsui

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  1. Hiroki Iida
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  2. Yoshihito Sakai
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Contributions

Hiroki Iida carried out the studies and drafted the manuscript. Hiroki Iida prepared figures and tables. Taisuke Seki, Yoshihito Sakai, and Shiro Imagama participated in the development of the study design and helped to draft the manuscript. Hiroki Iida, Yoshihito Sakai, Tsuyoshi Watanabe, Norimitsu Wakao, and Hiroki Matsui recruited and monitored the participants. All authors read and approved the final manuscript.

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Correspondence to Hiroki Iida.

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Ethics approval

This study was approved by National Center for Geriatrics and Gerontology review board and all experiments were performed in accordance with the ethical standards laid down in the amended Declaration of Helsinki. This study was conducted with the ethics committee of National Center for Geriatrics and Gerontology, Obu, Japan (approval number: No. 1124).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Iida, H., Sakai, Y., Seki, T. et al. Bisphosphonate treatment is associated with decreased mortality rates in patients after osteoporotic vertebral fracture. Osteoporos Int 33, 1147–1154 (2022). https://doi.org/10.1007/s00198-021-06264-z

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  • DOI: https://doi.org/10.1007/s00198-021-06264-z

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