Abstract
There is no clear evidence how effective the antiresorptive (AR) drugs alendronate and raloxifene are at reducing risk of second hip fracture and mortality in dialysis populations. The purpose of this study was to compare the risk of hospitalization for second hip fracture and risk of mortality between AR user and non-user groups in Taiwanese women on long-term dialysis with hip fractures. We conducted a retrospective cohort study using Taiwan National Health Insurance Research Datasets. Long-term dialysis women older than 50 years with newly diagnosed hip fractures and new to AR therapy from 2005 to 2011 were recruited. The patients were divided into AR users and non-users and matched by propensity score. We used Cox Proportional Hazards models to assess association of AR with risks of second hip fracture and mortality. Totally, 1,079 dialysis patients were included, and after matching, we were left with 74 AR users and 74 non-users. AR users did not show a significant reduction in the incidence of second hip fracture compared with non-users (adjusted Hazard Ratio (HR): 0.91, 95% CI: 0.30-2.76), and alendronate users exhibited higher risk of second hip fracture compared with raloxifene users (adjusted HR: 2.80, 95% CI: 0.42-18.79). In addition, AR users were found to have significantly lower 1- and 2-year mortality rates than the non-users (1- year: adjusted HR 0.25, 95% CI, 0.07-0.90; 2-year: 0.35, 95%CI: 0.17-0.72). AR treatment did not significantly improve the risk of second hip fracture but significantly reduce mortality in older women on dialysis. Further clinical trials on effectiveness of AR medications for dialysis populations should be warranted.
Highlights
Osteoporosis is a systematic disease that causes decreased bone strength and risk of fractures [1]
We extracted data for all cases diagnosed with endstage renal disease from the Registry of Catastrophic Illness Database and kept those patients who had the prescription of dialysis treatment for more than 90 days to ensure that only patients with long-term dialysis were included
This study identified 112,883 patients on long-term dialysis during the study period from 2004 to 2011, and 7,463 patients with newly diagnosed hip fractures were found during this period
Summary
Osteoporosis is a systematic disease that causes decreased bone strength and risk of fractures [1]. Risk of mortality following hip fracture is estimated to be at least double for age-matched control populations [3], with the main cause of death being infection due to being bedridden over a long period. Identifying high risk groups and effective treatment methods is vital for fracture prevention and mortality reduction. Renal function impairment has been mentioned as being highly related to excessive risk of hip fracture [4]. High risk of refracture with quite poor prognosis is anticipated in this population, recent clinical trials usually list patients with low renal function as exclusion criteria, resulting in little scientific evidence to suggest appropriate clinical practice; results from real-world data offer opportunities to bridge this gap and add primary information of effective size for future randomized clinical trial design
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