ECTS Abstracts (2015) 1 OC2.6

Gender-specific effects of bisphosphonates on mortality among Austrian hip fracture patients aged [ge]50 years

Wolfgang Brozek1, Berthold Reichardt2, Jochen Zwerina1, Hans Peter Dimai3, Klaus Klaushofer1 & Elisabeth Zwettler1


1Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Vienna, Austria; 2Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Eisenstadt, Austria; 3Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria.


We retrospectively analysed effects of bisphosphonates (BPs) on mortality in Austrian hip fracture patients. For 31 668 patients ≥50 years sustaining a hip fracture in Austria between July 2008 and December 2010, information on survival with follow-up until June 2011 and on prescription of BPs between July 2007 and June 2011 was available. Using Cox and logistic regression analysis, cumulative all-cause mortality among patients who started treatment before or after fracture was compared with that among age- and sex-matched hip fracture patients without anti-osteoporotic medication. The minimum prescription interval was set at half a year, and matched subjects had to be alive during the prescription interval of his/her assigned treated subject. Compared with female patients receiving no anti-osteoporotic prescription, women who initiated BPs before first fracture (n=8,868) displayed unaltered short-term mortality (hazard ratio (HR) at 90 days after fracture: 0.91 (95%-CI: 0.76–1.09, P=0.30)) but decreased long-term mortality (odds ratios (ORs) at one year and 3 years’ post-fracture, respectively: 0.70 (0.62–0.79, P<0.0001), 0.68 (0.61–0.76, P<0.0001)). Women starting BPs after first fracture (n=3,216) exhibited relative HRs of 0.29 (0.16–0.55, P<0.001) and 0.39 (0.29–0.52, P<0.0001) 1 year and 3 years’ post-fracture, respectively. For males using BPs already before fracture (n=837), no statistically significant reduction in mortality emerged, however, lowered mortality at one year post-fracture was observed for men treated only after fracture (n=633) (HR 0.12 (0.02–0.88), P<0.05). Among hip fracture patients using BPs, mortality was reduced predominantly in females. The smaller effect of BPs on pre-fracture users’ relative to post-fracture users’ survival might reflect a selection bias inherent to this observational study with more co-morbidity among BP users than non-users. However, the high extent of mortality reduction found in post-fracture BP users portends a causal relationship with anti-resorptive treatment with BPs.

Disclosure: The authors declared no competing interests.

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