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Hip fracture risk and safety with alendronate treatment in the oldest-old
Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden / Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
Institute for Health and Ageing, Catholic University of Australia, Melbourne, Vic., Australia.
University of Skövde, School of Health and Education. University of Skövde, Health and Education. (Individ och samhälle, Individual and Society – VIDSOC)ORCID iD: 0000-0002-6549-086X
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2017 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 282, no 6, p. 546-559Article in journal (Refereed) Published
Abstract [en]

Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied. Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety. Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term. Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI. Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017. Vol. 282, no 6, p. 546-559
Keywords [en]
alendronate, efficiency, elderly, fracture, osteoporosis, treatment
National Category
Orthopaedics Social and Clinical Pharmacy Bioinformatics (Computational Biology)
Research subject
Individual and Society VIDSOC
Identifiers
URN: urn:nbn:se:his:diva-14567DOI: 10.1111/joim.12678ISI: 000415928700007PubMedID: 28857352Scopus ID: 2-s2.0-85034421273OAI: oai:DiVA.org:his-14567DiVA, id: diva2:1163671
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-02-16Bibliographically approved

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Lundh, Dan

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