Effectiveness of Bisphosphonates in Young Adults With Fragility Fractures: Representative Population-based Cohort
Sung Hye Kong1,2, Ju-Young Park3,4, Moon-Kyung Shin5
1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
Context:
Fragility fractures in young adults present significant clinical challenges due to the limited evidence on the effectiveness of bisphosphonates in preventing subsequent fractures.
Objective:
To evaluate the effectiveness of bisphosphonate therapy in reducing the fracture risk among premenopausal women with a history of osteoporotic fractures.
Design:
A population-based retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort in South Korea, covering the years 2003 to 2014.
Setting:
A nationwide healthcare setting utilizing a representative cohort database.
Participants:
Among 2087 premenopausal women with osteoporotic fractures, participants were propensity score-matched based on age and body mass index at a 1:3 ratio, resulting in 132 bisphosphonate users and 396 nonusers.
Intervention:
Bisphosphonate treatment.
Main Outcome Measures:
The incidence of osteoporotic fractures.
Results:
Bisphosphonate users had a significantly lower risk of major osteoporotic fractures [hazard ratio (HR) 0.618, 95% confidence interval (CI) 0.396-0.963] compared to nonusers. Ibandronate users showed significant reductions in both major osteoporotic (HR 0.376, 95% CI 0.164-0.861) and nonvertebral fractures (HR 0.214, 95% CI 0.052-0.877). Also, longer duration of bisphosphonate use (≥180 days) was associated with a significantly lower risk of major osteoporotic and nonvertebral fractures (HR 0.528, 95% CI 0.300-0.929; HR 0.409, 95% CI 0.187-0.895, respectively).
Conclusion:
Bisphosphonate therapy significantly reduces fracture risk in premenopausal women with previous osteoporotic fractures, especially at higher cumulative doses. These findings support considering bisphosphonates as a treatment option in premenopausal women at high risk of fractures.
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