Osteoporosis is undertreated in patients who experience a hip fracture, and the use of alendronate in these individuals is associated with a reduced risk for cardiovascular (CV) mortality, myocardial infarction (MI), and stroke, according to the results of a retrospective cohort study published in the Journal of Bone and Mineral Research.

The researchers sought to explore the risk for CV events with and without the use of alendronate in patients with hip fracture using a population-wide database managed by the Hong Kong Hospital Authority. Patients who were newly diagnosed with hip fracture between 2005 and 2013 were followed until November 6, 2016. They examined the use of alendronate and other anti-osteoporosis medications. Treated and non-treated patients were matched based on time-dependent propensity scores. Outcomes were assessed at 1, 3, 5, and 10 years in order to examine the associations over time.

Of 34,991 patients with newly diagnosed hip fracture, 13.2% received anti-osteoporosis therapy during follow-up. A total of 4594 treated patients were matched with 13,568 non-treated patients.


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Neither physical functioning nor survival prospect differed significantly between the treated and non-treated participants.

According to the results of a Cox regression analysis, treatment with alendronate was associated with a significantly lower risk for 1-year CV mortality (hazard ratio [HR], 0.33; 95% CI, 0.17-0.65; P =.001) and incident MI (HR, 0.55; 95% CI, 0.34-0.89; P =.014). Moreover, a marginally significant reduction in the risk for stroke was observed at 5 years (HR, 0.82; 95% CI, 0.67-1.00; P =.049) and at 10 years (HR, 0.83; 95% CI, 0.69 to 1.01; P =.065). Although the strength of the association declined over time, it remained statistically significant.

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The investigators concluded that additional studies in other populations and randomized trials are warranted in order to further comprehend the relationship between the use of various anti-osteoporosis medications and the risk for CV events in patients with hip fracture.

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Reference

Sing C-W, Wong AYS, Kiel DP, et al. Association of alendronate and risk of cardiovascular events in patients with hip fracture [published online May 9, 2018]. J Bone Miner Res. doi:10.1002/jbmr.3448