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Does treatment with bisphosphonates protect against fractures in real life? The HUNT study, Norway

Author

Osteoporos Int. 2021 Jan 21. doi: 10.1007/s00198-021-05845-2. Online ahead of print.

M Hoff 1 2 3E Skovlund 4 5H E Meyer 5 6A Langhammer 7 8A J Søgaard 5U Syversen 9 10K Holvik 5B Abrahamsen 11 12B Schei 4 13

Author Information

1 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. mari.hoff@ntnu.no.

2 Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. mari.hoff@ntnu.no.

3 Department of Rheumatology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway. mari.hoff@ntnu.no.

4 Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.

5 Norwegian Institute of Public Health, Oslo, Norway.

6 Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway.

7 HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.

8 Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.

9 Department of Endocrinology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.

10 Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.

11 Department of Medicine, Holbæk Hospital, Holbæk, Denmark.

12 Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.

13 Department of Gynecology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.

Abstract

Bisphosphonates reduce fractures in randomized controlled trials (RCT); however, there is less information from real life. In our population including 14,990 women and 13,239 men, use of bisphosphonates reduced risk of fractures in hip and forearm in women. The magnitude of the effect was comparable to results from RCT.

Introduction: The objective was to examine if treatment with bisphosphonates (BPs) was associated with reduced risk of fractures in the hip and forearm in women and men in the general population.

Methods: In a cohort study based on data from the third wave of the population-based HUNT Study (HUNT3), the fracture registry in Nord-Trøndelag, and the Norwegian Prescription Database, 14,990 women and 13,239 men 50-85 years were followed from the date of participating in HUNT3 (2006-2008) until the date of first fracture in the hip or forearm, death, or end of study (31 December 2012). Hazard ratios with 95% confidence intervals for hip and forearm fracture according to use of BPs were estimated using Cox proportional hazards models with time-dependent exposure. Adjustment for individual FRAX® fracture risk assessment scores was included.

Results: BPs, predominantly alendronate, were used by 9.4% of the women and 1.5% of the men. During a median of 5.2 years of follow-up, 265 women and 133 men had a hip fracture, and 662 women and 127 men had a forearm fracture. Compared with non-users of BPs, the hazard ratios with 95% confidence interval for a fracture among users of BPs adjusted for age and FRAX® were 0.67 (0.52-0.86) for women and 1.13 (0.50-2.57) for men. Among users of glucocorticoids, the corresponding figures were 0.35 (0.19-0.66) and 1.16 (0.33-4.09), respectively.

Conclusions: Use of BPs was associated with reduced risk of fractures in hip and forearm in women, and the magnitude of effect is comparable to results from RCTs.