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Alendronate reduces hip fracture risk in elderly patients on prednisolone

Tristan Manalac
28 Jul 2017

Alendronate significantly reduces the risk of hip fracture in elderly adults on medium to high doses of prednisolone, a new study has shown.

“In this retrospective cohort study of older men and women using prednisolone, alendronate treatment for a median duration of 2.9 years was associated with lower risk of hip fracture than no alendronate treatment,” researchers said.

In a cohort of 1,802 elderly adults on oral prednisolone and alendronate (mean age 79.9±7.1 years; 70.8 percent female), the main outcome of hip fracture was reported in 27 individuals, yielding an incidence rate of 9.5 fractures per 1,000 person-years. [JAMA 2017;318:146-155]

On the other hand, the control group of 1,802 elderly participants on oral prednisolone alone (mean age 80.0±7.8 years; 69.3 percent female) had a hip fracture incidence rate of 27.2 fractures per 1,000 person-years (n=73). The median follow-up was 1.32 (0.57 to 2.34 years).

The risk of hip fracture was significantly lower in participants who received alendronate compared to prednisolone-only controls even after adjusting for age, weight, height and sex (hazard ratio [HR], 0.35; 95 percent CI, 0.23 to 0.55; p<0.001) and for other additional covariates (HR, 0.53; 0.22 to 0.54; p<0.001).

The multivariable Cox model also showed a 30-month absolute risk reduction of 4.1 percent (2.8 to 5.4 percent; p<0.001) for participants on alendronate.

“The observed 65 percent relative risk reduction for hip fracture in this study exceeds the 40 percent risk reduction observed in women with postmenopausal osteoporosis in randomized trials with alendronate,” researchers said. [Cochrane Database Syst Rev 2008;CD00115]

This was expected, however, “because the greatest relative risk reductions are usually seen in patients with several strong risk factors and therefore particularly high fracture risk, such as those treated with glucocorticoids,” they added. [Lancet 1996;348:1535-1541]

Alendronate use also significantly reduced the risk of secondary outcomes including major osteoporotic fractures (HR, 0.53; 0.38 to 0.73; p<0.001), any fractures (HR, 0.58; 0.46 to 0.73; p<0.001) and nonvertebral fractures (HR, 0.55; 0.43 to 0.71; p<0.001) after adjusting for all covariates. The 30-month absolute risk reductions for major osteoporotic fractures, any fractures and nonvertebral fractures were 3.9 (2.2 to 5.4 percent; p<0.001), 5.7 (3.9 to 8.0 percent; p<0.001) and 5.5 (3.6 to 7.5 percent; p<0.001) percent, respectively.

Elderly patients at least 65 years of age and with baseline health evaluation information were included in the study. Relevant information was retrieved from the Senior Alert national database. Exclusion criteria included metastatic cancers and severe kidney failure.

“Among older patients using medium to high doses of prednisolone, alendronate treatment was associated with a significantly lower risk of hip fracture,” said researchers. “Although the findings are limited by the observational study design and the small number of events, these results support the use of alendronate in this patient group.”

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