Bisphosphonate treatment and mortality risk reduction after osteoporotic hip fracture
Authors: Maria Diehl, Andrea Beratarrechea, Natalia Pace, Javier Saimovici, Adriana Trossero, Gastón Perman, Luisa Plantalech
Abstract
Less than 30% of patients are treated for osteoporosis after hip fracture (HF). Treatment with bisphosphonates (BP) is associated with a reduction in mortality risk in some studies. The aim of this study was to analyze the impact on mortality and osteoporosis treatment of a secondary prevention program for patients with HF. Patients hospitalized in 2005-2006 (CH) and 2008-2009 (CI) were included. Patients of CI were invited to participate in a program for osteoporosis treatment. Survival up to 30 months was analyzed using the Kaplan-Meier method. BreslowGehan test was used to compare survival curves. Predictor factors were assessed using Coxs model. There were 252 patients (79.5 ± 8.1 years) in CH, and 252 (81.5 ± 7.2 p 0.04) in CI. In CI, 44 % agreed to participate in the program (CIP). The proportion of patients who received post-HF bisphosphonates (BP) increased from 38.5% in CH to 54.8% in CI (p <0.001). Survival at 30 months was 94.2% (87.5-97.3) in CIP vs 78.7% (69-85.7) in CI who did not participate and 81.4% (75.7-85.9) in CH (p <0.006). Patients treated with BP after HF had better survival compared with non-treated patients, 88,6% (83.4-92.3) vs 79,6% (43.7-84.3), p: 0.008. The variables associated with mortality in multivariate analysis were age, diabetes and dementia. Treatment with BP after HF was associated with lower mortality risk (HR 0.20 IC 0.09-0.41 p <0.001). Survival was better in patients with BP treatment after HF. We consider important to develop strategies to improve osteoporosis evaluation and treatment after HF.
Key words: Hip fractures, bisphosphonates, secondary prevention, mortality, osteoporosis.
