Mortality risk higher for men and women with osteoporosis
Men and women younger than 70 years with osteoporosis show an increased mortality risk, particularly in the first few years of treatment of the disease, according to research in the Journal of Bone and Mineral Research Study.
In an observational cohort study, researchers showed that although the mortality risk is higher in both men and women after beginning an osteoporosis treatment, that risk is reduced over time, suggesting new strategies are needed for managing the disease in advanced age.
“Despite the known excess mortality in patients suffering from osteoporosis, life expectancy of newly diagnosed and treated osteoporosis patients is in excess of 15 years in women below the age of 75 and in men below the age of 60 who are treated for osteoporosis, highlighting the importance of developing clear guidelines for the management of long-term treatment,” the researchers wrote.
Bo Abrahamsen, MD, PhD, from the Research Center of Aging and Osteoporosis at Glostrup Hospital in Denmark, and colleagues at other institutions analyzed data from 58,637 patients who began treatment for osteoporosis from 1996 to 2003 and 225,084 gender-matched controls. Researchers used Danish national registries to track filled osteoporosis medication prescriptions, the National Hospital Discharge Database to identify comorbid conditions and the National Cause of Death Register to obtain information about the primary cause of death through 2013, providing a follow-up period of 10 to 17 years.
Researchers analyzed survival in patients with osteoporosis beginning at the time they were diagnosed and issued their first prescription, either for first-line drugs or drugs reserved for advanced osteoporosis. Patients whose risk for fracture was too low to require treatment were not included in the study.
After 1 year, the mortality rate for men being treated with osteoporosis medications was 16% compared with 3% for controls and 6.6% for women with osteoporosis prescriptions compared with 4.6% for controls. At 5 years, the mortality rates were 48.2% in men treated for osteoporosis and 24.6% in controls and 28.3% in women with osteoporosis and 31.9% in controls. The mortality rate at 10 years was 69.7% in men (45.4% in controls) and 50.2% in women (50.8% in controls).
“In men below age 80 and women below age 60, the relative risk of dying declined from being strongly increased in the first year to a stable but elevated level in subsequent years,” the researchers wrote. “In women older than 65 to 70 years, there was only a small elevation in risk in the first year of treatment followed by lower than background (control) mortality.”
Remaining life expectancy of a man at age 50 years who began osteoporosis treatment was estimated to be 18.2 years (26.4 years for women) and 7.5 years for a man at age 75 years (13.5 years for women), according to researchers.
Because patients being treated for osteoporosis were more likely to have prior fractures and other chronic comorbid conditions, they also had a six times higher prevalence of collagen and rheumatic diseases, a four times higher prevalence of chronic pulmonary diseases and twice the prevalence of prior fractures after age 50 years.
The study highlights the need for long-term management tools and strategies, according to researchers.
“As clinicians it is important that we are not complacent,” Abrahamsen told Endocrine Today. “Starting treatment for osteoporosis is simple but we really need to develop evidence-based strategies for the long term management of our patients with osteoporosis. Unfortunately there is very little data about the efficacy of osteoporosis drugs after ten or fifteen years of use.” – by Regina Schaffer
Disclosure: Abrahamsen reports receiving research grants or serving as an investigator in studies for Amgen, Novartis, NPS Pharmaceuticals and Nycomed/Takeda; has served as a national advisory board member for Amgen, Merck and Nycomed/Takeda; and received speakers’ fees from Amgen, Eli Lilly, Merck and Nycomed/Takeda. See the full study for a list of the other authors’ relevant financial disclosures.