Research Paper Volume 14, Issue 5 pp 2239—2251
The association between osteoporosis medications and lowered all-cause mortality after hip or vertebral fracture in older and oldest-old adults: a nationwide population-based study
- 1 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 2 Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 3 International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
- 4 Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- 5 Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
- 6 Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- 7 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 8 Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 9 Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
Received: December 7, 2021 Accepted: February 15, 2022 Published: March 1, 2022https://doi.org/10.18632/aging.203927
How to Cite
Copyright: © 2022 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Osteoporotic fracture is a common public-health problem in ageing societies. Although post-fracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old).
Methods: Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018.
Results: A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture).
Conclusions: Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.
NHI: National Health Insurance; NHIRD: National Health Insurance Research Databank; DALYs: disability-adjusted life years; CCI: Charlson-Deyo comorbidity Index; IPTW: inverse probability of treatment weighting; PS: propensity score; TFDA: Taiwan Food and Drug Administration; SD: standard deviation.