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Bisphosphonate Protects Against Hip Fracture in Patients on Steroids

July 11, 2017

By Megan Brooks

NEW YORK (Reuters Health) - The osteoporosis drug alendronate reduces the risk of hip fracture in older patients on medium to high doses of the anti-inflammatory steroid prednisolone, according to results of a Swedish retrospective cohort study online today in JAMA.

Oral glucocorticoid therapy can produce rapid bone loss, raising the risk of fracture, Dr. Mattias Lorentzon of the University of Gothenburg and colleagues note in their article.

“It has previously been shown that alendronate reduces the risk of vertebral fractures in patients using oral glucocorticoids, but there were no studies regarding hip fractures, which are the most severe osteoporotic fractures, often leading to disability and increased risk of premature death,” Dr. Lorentzon told Reuters Health by email.

To investigate, the study team did a propensity-matched analysis of 1802 patients who had been prescribed alendronate after at least 3 months of oral prednisolone (5 mg/d or higher), and 1802 patients who took prednisolone without alendronate. Participants were 80 years on average and 70% were women. The median time on alendronate prior to baseline was 2.9 years.

After a median follow-up of 1.3 years, there were 27 hip fractures in the alendronate group and 73 in the no-alendronate group, corresponding to incidence rates of 9.5 and 27.2 fractures per 1000 person-years, with an absolute rate difference of -17.6, the investigators report.

Alendronate treatment was associated with lower of risk of hip fracture (hazard ratio, 0.35) in an unadjusted Cox model and the risk estimate did not substantially change in multivariable-adjusted Cox models, they note. The absolute risk reduction based on the multivariable Cox model was estimated to be 4.1%.

The associations were maintained for women but lacked statistical power among men, the investigators say. The protective effect of alendronate on hip fracture was seen in patients taking both medium- and high-dose prednisolone, and greater time on alendronate was associated with a lower risk of hip fracture.

Summing up, Dr. Lorentzon said, “Oral prednisolone increases fracture risk and is a fairly common treatment in older patients, but few patients receive osteoporosis medication to prevent fractures. Our study supports the use of alendronate in older patients taking oral prednisolone in medium to high doses, in order to prevent hip fractures.”


JAMA 2017.

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