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Effectiveness of antiresorptive agents in the prevention of recurrent hip fractures

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Abstract

Summary

Hip fracture is associated with recurrent fractures and increased mortality. The results of our retrospective cohort study support the use of antiresorptive agents to prevent recurrent hip fractures in this population.

Introduction

Hip fracture, the most serious consequence of osteoporosis, is associated with recurrent fractures and increased mortality. Antiresorptive therapy has proven efficacy in the prevention of fractures after vertebral fractures. It is unknown if it can prevent recurrent fractures after a hip fracture.

Methods

We designed a population based, retrospective cohort study, using administrative databases and identified patients hospitalized for a hip fracture between 1996 and 2002. The exposure was defined as being dispensed a prescription for an antiresorptive agent at any time following discharge. Multivariate Cox regression models were used to estimate the hazard ratio of recurrent hip fracture. Subgroup and propensity score analyses were performed.

Results

A total of 20,644 patients were identified; 6,779 filled a prescription for antiresorptive agents. There were 992 recurrent hip fractures. Patients exposed to antiresorptives had a 26% reduction in the rate of recurrent fractures (adjusted hazard ratio 0.74; 95% CI, 0.64–0.86) compared to patients who were not. All subgroups experienced a reduction in recurrent fracture, except the very elderly. Propensity score analyses were consistent with the main analysis.

Conclusions

Antiresorptive therapy reduces the risk of recurrent hip fractures in elderly patients. These results provide evidence that this therapy should be considered for secondary prevention of hip fractures.

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Acknowledgements

This study was funded in part by grant #ATF 6669 from the Canadian Institutes of Health Research. Dr. Morin is a scholar of the CIHR Skeletal Health Training Program. The funding agency had no role in the design of the study, in the collection, analysis and interpretation of the data, in the writing of the manuscript and in the decision to submit the paper for publication.

Conflict of interest statement

Dr. Morin has received honoraria (consultant and speaker fees) from the Alliance for Better Bone Health, Merck and Eli Lilly. Dr. Rahme has received grants and consultant fees from Merck, Pfizer and Boehringer Ingelheim. All other authors have no conflict of interest.

Authors contributions:

  • Drs Morin and Pilote were responsible for the conception of the study.

  • Dr. Pilote was responsible for acquisition of the data.

  • Drs. Morin and Behlouli were responsible for the data programming.

  • Drs. Morin, Pilote, Rahme, Behlouli and Goltzman were responsible for the design of the study, data analysis and interpretation.

  • Dr. Morin was responsible for writing the manuscript.

  • All authors were responsible for revising the manuscript critically for important intellectual content.

  • All authors have seen and approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Division of Internal Medicine, McGill University Health Center (MUHC), 1650 Cedar Ave, Room B2-118, Montreal, QC, H3G 1A4, Canada

    S. Morin, E. Rahme, H. Behlouli, A. Tenenhouse, D. Goltzman & L. Pilote

  2. Clinical Epidemiology, the Research Institute of the McGill University Health Center, 1650 Cedar Ave, Room B2-118, Montreal, QC, H3G 1A4, Canada

    S. Morin, E. Rahme, H. Behlouli, A. Tenenhouse, D. Goltzman & L. Pilote

Authors
  1. S. Morin
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  2. E. Rahme
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  3. H. Behlouli
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  4. A. Tenenhouse
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  5. D. Goltzman
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  6. L. Pilote
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Corresponding author

Correspondence to S. Morin.

Additional information

Dr. Morin is a Canadian Institutes of Health Research Bone Scholar, Dr. Pilote is funded by the Canadian Institutes of Health Research. Dr. Pilote is a William Dawson Professor of Medicine at McGill University. This study was supported in part by a grant from the Canadian Institutes of Health Research (#ATF-66669).

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Morin, S., Rahme, E., Behlouli, H. et al. Effectiveness of antiresorptive agents in the prevention of recurrent hip fractures. Osteoporos Int 18, 1625–1632 (2007). https://doi.org/10.1007/s00198-007-0421-1

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  • DOI: https://doi.org/10.1007/s00198-007-0421-1

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