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.

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