Abstract
Bisphosphonates are widely used in the treatment of women at risk of osteoporotic hip fracture; however, the overall effectiveness of bisphosphonates in the prevention of osteoporotic fractures has not been studied in real life. To investigate whether the use of bisphosphonates in women aged 50 years and over is associated with a decrease in hospitalization for osteoporotic hip fractures, a historical prospective cohort study was conducted between 2009 and 2016 from a permanent representative sample consisting of 1/97 of the French health insurance beneficiaries. Bisphosphonate use was defined according to medication persistence and adherence regarding bisphosphonate dispensations. The primary outcome was the hospitalization rate for osteoporotic hip fracture. Among the 81,268 women included, 2005 were exposed to bisphosphonates. The median time of bisphosphonate exposure was 12 (IQR, 3–29) and 17 (IQR, 5–42) months for the persistence and adherence definitions, respectively. Exposure to bisphosphonates was not associated with a decrease in hospitalization for hip fracture: weighted HRadherence = 0.66 (95% CI, 0.33 to 1.33); HRpersistance = 0.77 (95% CI, 0.38 to 1.57). In real life, bisphosphonate use does not appear to reduce hospitalization for hip fractures, as to date, it is probably prescribed as primary prevention and for a duration too short to be effective.
Highlights
IntroductionHip fractures have the strongest association with mortality [2]
The proportion of previous osteoporotic hip fracture is statistically higher in the exposed group but remains comparable (0.9 vs. 0.3)
Weighted and unweighted analyses for women aged 75 and older (Table 3) displayed no significant associations between exposure and osteoporotic hip fracture, regardless of the exposure definition considered. This is the largest historical prospective cohort study that investigates the association between the exposure to bisphosphonates and hospitalization for osteoporotic hip fracture
Summary
Hip fractures have the strongest association with mortality [2]. The risk of death from any cause is six times higher for women after a hip fracture than for women without hip fracture. This risk decreases during the first two years after hip fracture, but it remains higher compared to the general population of the same age [2]. Age is an important risk factor for mortality after hip fracture, e.g., the risk of all-cause mortality in patients over 70 years of age is five to eight times higher in the first three months after a hip
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