TOPLINE:
Anti-osteoporosis medications reduce fracture risk similarly, regardless of whether patients are younger or older than 70 years.
METHODOLOGY:
- Investigators conducted the study as part of a joint UK and US project to assess bone mineral density as a surrogate marker for fracture risk.
- Analyses used individual patient data from 23 randomised placebo-controlled trials of anti-osteoporosis medications (11 of bisphosphonates, four of selective oestrogen receptor modulators, three of anabolic medications, two of hormone replacement therapy, and one each of odanacatib, denosumab, and romosozumab).
- Overall, 43% of the included 123,164 patients were aged 70 years or older.
- The main outcomes were fractures and bone mineral density.
TAKEAWAY:
- Anti-osteoporosis medication roughly halved the risk for vertebral fracture among both patients younger than 70 years and patients aged 70 years or older (odds ratio, 0.47 vs 0.51; P for interaction = .19).
- There was also a similar benefit regardless of age when it came to the reduction in risks for hip fracture (odds ratio, 0.65 vs 0.72; P for interaction = .50) and any fracture (odds ratio, 0.72 vs 0.70; P for interaction = .20).
- Findings were comparable in analyses restricted to bisphosphonate trials, except that the reduction in hip fracture risk was greater among the younger group (hazard ratio, 0.44 vs 0.79; P for interaction = .02).
- The benefit of anti-osteoporosis medication in increasing hip and spine bone mineral density at 24 months was significantly greater among the older patients.
IN PRACTICE:
Taken together, the study results "strongly support treatment in those over age 70," the authors wrote. "These are important findings with potential impact in patient treatment since it goes against a common misconception that medications are less effective in older people," they added.
SOURCE:
The study was led by Marian Schini, MD, PhD, FHEA, University of Sheffield, Sheffield, UK, and was published online in the Journal of Bone and Mineral Research.
LIMITATIONS:
Limitations included a preponderance of female patients (99%), possible residual confounding, a lack of analysis of adverse effects, and potentially different findings using alternate age cutoffs.
DISCLOSURES:
The study was funded by the American Society for Bone Mineral Research. Some authors disclosed affiliations with companies that manufacture anti-osteoporosis drugs.
