Lower Risk for Hip Fracture With Alendronate Use Among Older Patients

Treatment with the osteoporosis drug alendronate in elderly patients using medium to high doses of prednisolone was associated with a lower risk for hip fracture, according to a study published in JAMA.

Although oral glucocorticoid therapy is frequently used to treat inflammatory conditions, it can increase fracture risk. “Glucocorticoids are associated with an increased rate of fracture, and higher doses and longer use of glucocorticoids are associated with higher risks of fracture,” Mattias Lorentzon, MD, PhD, from the University of Gothenburg, Sweden, reported in the study.

Dr Lorentzon and colleagues conducted a retrospective cohort study to determine whether alendronate prescribed to patients treated with prednisolone was associated with reduced risk for hip fracture in a large cohort of older men and women.

They used a national database to identify patients who were 65 years of age or older and were prescribed alendronate at a healthcare facility after at least 3 months of oral prednisolone treatment (at least 5 mg/day).

Follow-up occurred for the 1802 participating patients between January 2008 and December 2014 at an average rate of 1.32 years. There were 27 hip fractures in patients receiving concomitant alendronate and 73 hip fractures cited in the group not receiving alendronate. This corresponded to incidence rates of 9.5 (95% CI, 6.5-13.9) and 27.2 (95% CI, 21.6-34.2) fractures per 1000 person-years. In addition, the absolute reduction in hip fracture risk for those also taking alendronate was 4.1% (95%, CI, 2.8%-5.4%) at 30 months. These associations were statistically significant for women, but not for men.

“Among older patients using medium to high doses of prednisolone, alendronate treatment was associated with a significantly lower risk of hip fracture over a median of 1.32 years,” the researchers said. “[T]hese results support the use of alendronate in this patient group.”

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Reference

Axelsson KF, Nilsson AG, Wedel H, Lundh D, Lorentzon M. Association between alendronate use and hip fracture risk in older patients using oral prednisolone. JAMA. doi: 10.1001/jama.2017.8040