An international study led by Monash University’s Centre for Medicine Use and Safety (CMUS) has shed light on the comparative risks of second hip fractures, other subsequent fractures, and mortality in people prescribed 2 commonly used osteoporosis medicines.
Published in Osteoporosis International, the research analysed the outcomes for patients in Australia, Hong Kong, Taiwan and the United Kingdom using parallel population-based cohort studies.
The researchers compared the treatment outcomes of people prescribed bisphosphonates and denosumab following their first hip fracture.
Overall, bisphosphonate users had a 25% higher rate of any subsequent fracture than denosumab users.
However, men using bisphosphonates rather than denosumab had a lower rate of death.
People with and without dementia appeared to derive similar benefits from each medication.
The researchers say this is important because people with dementia and frailty are often under-treated with osteoporosis medications after experiencing a hip fracture, despite being at high risk of subsequent fractures.
“We set out to investigate the risk of fracture and death in people with dementia and frailty prescribed bisphosphonates or denosumab.
“We found no significant difference in treatment outcomes in people with or without dementia or frailty. We did, however, identify an unexpected sex-related difference.
“Our hope is that this study is a building block toward better-informed practice moving forward,” Associate Professor Jenni Ilomaki, from CMUS and the study’s lead author, said.
Director of CMUS and senior author of the study, Professor Simon Bell, says the relative effectiveness of first-line osteoporosis medications post-hip fracture in people with dementia or frailty remains poorly researched.
“Our research is important because 1 in 5 people who experience a hip fracture have dementia, yet people with dementia are less likely to receive osteoporosis treatment and have a higher risk of second fractures and post-fracture mortality,” Professor Bell said.
The authors, who specialise in analysing the safe and effective use of medications, particularly in older populations, believe research into the effectiveness of bone-strengthening medications in people with dementia or frailty post-fracture warrants further investigation.
“We know from previous studies that fall-related injuries are common in people with dementia and that second hip fracture is two-fold higher in people with dementia than without dementia,” Professor Bell said.
“Despite the high incidence of hip fractures in people with dementia, most osteoporosis clinical guidelines don’t make specific treatment recommendations for people with dementia or frailty – this is a gap that needs to be addressed.”
