TY - JOUR
T1 - Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting
T2 - A prospective cohort study
AU - van Geel, Tineke A. C. M.
AU - Bliuc, Dana
AU - Geusens, Piet P. M.
AU - Center, Jacqueline R.
AU - Dinant, Geert-Jan
AU - Thach Tran, Thach
AU - van den Bergh, Joop P. W.
AU - McLellan, Alastair R.
AU - Eisman, John A.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - ObjectiveOsteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed.Materials and methodsIn this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models.ResultsThose recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p <0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49 +/- 0.73) and lower mortality risk (HR: 0.79, 95% CI: 0.64 +/- 0.97).ConclusionOf the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality.
AB - ObjectiveOsteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed.Materials and methodsIn this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models.ResultsThose recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p <0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49 +/- 0.73) and lower mortality risk (HR: 0.79, 95% CI: 0.64 +/- 0.97).ConclusionOf the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality.
KW - DUBBO-OSTEOPOROSIS-EPIDEMIOLOGY
KW - OLDER WOMEN
KW - ELDERLY-WOMEN
KW - HIP FRACTURE
KW - VERTEBRAL FRACTURES
KW - BONE LOSS
KW - PREDICT MORTALITY
KW - ZOLEDRONIC ACID
KW - LIFETIME RISK
KW - MEN
U2 - 10.1371/journal.pone.0198006
DO - 10.1371/journal.pone.0198006
M3 - Article
SN - 1932-6203
VL - 13
JO - PLOS ONE
JF - PLOS ONE
IS - 6
M1 - 0198006
ER -