Do Osteoporosis Drug Treatments Reduce Morality?

Treatment with bisphosphonates in patients with osteoporosis does not reduce the risk of mortality, according to new findings.

“Previous studies have reported that drug treatments, particularly treatment with bisphosphonates, is associated with reduced overall mortality rates in addition to decreased fracture risk,” wrote the researchers, whose work was published in JAMA Internal Medicine. “If so, drug treatments should be recommended for this reason alone, regardless of a patient’s risk of fracture.”

The researchers conducted a meta-analysis using data from Science Direct, MEDLINE, Embase, and the Cochrane Library. Studies eligible for inclusion were randomized placebo-controlled, clinical trials and abstracts presented at annual osteoporosis society meeting conferences published between 2009 and April 19, 2019. All studies had a duration of at least one year. The primary outcome was the correlation between drug treatments (specifically bisphosphonate and zoledronate treatments) and mortality.

Of 2,045 potential trials, final analysis included 38. The data encompassed 101,642 patients: 45,594 placebo patients and 56,048 who received treatment. Six clinical trials evaluated zoledronate treatments (placebo, n = 6,944; treatment, n = 6,926), and 21 were of bisphosphonate treatments (placebo, n = 20,244; treatment, n = 22,623). In all evaluated drug treatments, there was no significant association with overall mortality rate (risk ratio [RR], 0.98; 95% confidence interval [CI], 0.91-1.05; I2 = 0%). Similar outcomes were observed in clinical trials of bisphosphonate treatment (RR, 0.95; 95% CI, 0.86-1.04). There was no correlation between zoledronate treatment and mortality (RR, 0.88; 95% CI, 0.68-1.13), but “evidence existed for heterogeneity of the results (I2 = 48.2%),” the authors noted.

The researchers wrote in sum, “Results of this meta-analysis suggest that bisphosphonate treatment may not be associated with reduced overall mortality rates in addition to decreased fracture risk and should only be recommended to reduce fracture risk. Additional trials are needed to clarify whether treatment with zoledronate reduces mortality rates.”