Comparisons Between Different Anti-osteoporosis Medications on Postfracture Mortality: A Population-Based Study

Area of Science:

• Gerontology
• Epidemiology
• Pharmacology

Background:

• Osteoporosis is a growing global health concern, particularly in aging populations.
• Anti-osteoporotic medications are crucial for fracture prevention, but their comparative effects on mortality require further investigation.

Purpose of the Study:

• To evaluate the real-world impact of various anti-osteoporotic medications on all-cause mortality.
• To stratify these effects by fracture site, patient sex, and age.

Main Methods:

• A longitudinal, population-based cohort study utilizing Taiwanese National Health Insurance Research Database data (2009-2018).
• Included over 46,000 patients aged 40+ with osteoporotic fractures treated with anti-osteoporotic medications.
• Multivariate Cox proportional hazards models were employed to analyze mortality risks, accounting for immortal time bias.

Main Results:

• Alendronate/risedronate, denosumab, and zoledronic acid were associated with significantly lower mortality compared to raloxifene and bazedoxifene.
• These findings were consistent across hip, vertebral, and non-hip/non-vertebral fracture sites.
• Long-acting zoledronic acid demonstrated the lowest mortality rates in subgroup analyses by sex and age (over 65).

Conclusions:

• Real-world data suggest that anti-osteoporotic medications can reduce post-fracture mortality.
• Long-acting medication regimens, particularly zoledronic acid, may offer the most significant survival benefits.