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Drug treatments for osteoporosis decrease fracture risk but not mortality

For patients with osteoporosis, no drug treatment was associated with reduced mortality rates, according to a study published in JAMA Internal Medicine. These treatments should, therefore, only be recommended to decrease fracture risk.

“The purpose of treating patients with medications for osteoporosis is to reduce the risk of fracture and the subsequent pain and disability,” Steven R. Cummings, MD, of the San Francisco Coordinating Center and the California Pacific Medical Center Research Institute, and colleagues wrote. “Preventing fractures may also lessen the increased risk of mortality owing to fractures. Some studies have suggested that treatments for osteoporosis may directly reduce overall mortality rates in addition to decreasing fracture risk...[However], it is possible that these associations were owing to other confounding factors that were not measured; for example, those who took drug treatments for the prevention of fracture may have had better health and nutrition, exercised more frequently, or used other preventive measures more often than those who did not.”

To evaluate if drug treatments for osteoporosis reduced overall mortality, researchers reviewed 38 randomized placebo-controlled clinical trials (total participants, 101,642) that were published between 2009 and 2019. Included in the meta-analyses were trials that assessed bisphosphonates, denosumab, selective estrogen receptor modulators, parathyroid hormone analogues, odanacatib, romosozumab and zoledronate.

 

For patients with osteoporosis, no drug treatment was associated with reduced mortality rates.

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Researchers found no significant associations between all drug treatments and overall mortality (risk ratio [RR] = 0.98; 95% CI, 0.91-1.05), bisphosphonate treatment and overall mortality (RR = 0.95; 95% CI, 0.86-1.04) or zoledronate treatment and overall mortality (RR = 0.88; 95% CI, 0.68-1.13).

“Drug treatments for osteoporosis, and treatments with bisphosphonates in particular, are not associated with reduced overall mortality rates in addition to decreased risk of fracture,” the researchers wrote. “Drug treatments for patients with osteoporosis should only be recommended for reducing fracture risk in accordance with clinical guidelines.” – by Melissa J. Webb

Disclosures: Cummings reports receiving grants and personal fees from Amgen. Please see the study for all other authors’ relevant financial disclosures.