Fracture risk

Previous studies have reported that drug treatments; particularly treatment with bisphosphonates, associated with reduced overall mortality rates in addition to decreased fracture risk. If so, drug treatments should be recommended for this reason alone; regardless of a patient’s risk of fracture. For patients with osteoporosis, no drug treatment associated with reduced mortality rates, according to a study published in JAMA Internal Medicine. 

These treatments should, therefore, 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.

Treatment of osteoporosis

“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.”

Included studies were clinical trials that (1)  randomized and placebo-controlled; (2) studied drug treatments with proven antifracture efficacy; (3) used agents at the approved dose for treatment of osteoporosis; and (4) had a duration of 1 year or more. Abstracts from the literature searches reviewed for inclusion and exclusion criteria; and mortality rate data abstracted from the article by 1 researcher and validated by a second. A total of 2045 records screened; 38 (1.8%) included in the meta-analyses.

To evaluate if drug treatments for osteoporosis reduced overall mortality; researchers reviewed 38 randomized placebo-controlled clinical trials (total participants, 101,642) that 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.

Reducing fracture risk

Researchers found no significant associations between all drug treatments; and overall mortality, bisphosphonate treatment and overall mortality or zoledronate treatment and overall mortality. “Drug treatments for osteoporosis, and treatments with bisphosphonates in particular, are not associated with reduce overall mortality rates in addition to decreased risk of fracture,” the researchers wrote.

“Drug treatments for patients with osteoporosis should only recommended for reducing fracture risk in accordance with clinical guidelines.” Results of this meta-analysis suggest that bisphosphonate treatment may not associated with reduced overall mortality rates in addition to decreased fracture risk and should only recommended to reduce fracture risks. Additional trials are needed to clarify whether treatment with zoledronate reduces mortality rates.