Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: A prospective cohort study

Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of or...

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Published in:	PloS one Vol. 13; no. 6; p. e0198006
Main Authors:	van Geel, Tineke A. C. M., Bliuc, Dana, Geusens, Piet P. M., Center, Jacqueline R., Dinant, Geert-Jan, Tran, Thach, van den Bergh, Joop P. W., McLellan, Alastair R., Eisman, John A.
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 01.06.2018 Public Library of Science (PLoS)
Subjects:	Administration, Oral Aged Alcohol use Analysis Biocompatibility Biology Biology and Life Sciences Biomedical materials Biomedical research Bisphosphonates Bone mineral density Calcium Care and treatment Cohort analysis Cohort Studies Confidence intervals Diphosphonates Diphosphonates - administration & dosage Diphosphonates - pharmacology Family medical history Female Fractures Fractures (Injuries) Fragility Health aspects Health risk assessment Health risks Hip Hospitals Humans Internal medicine Male Medical research Medicine Medicine and Health Sciences Men Middle Aged Mortality Mortality risk Older people Osteoporosis Osteoporotic Fractures - mortality Osteoporotic Fractures - prevention & control Patients Physical sciences Post-menopause Prospective Studies Public health Rheumatology Risk Risk factors Statistical models Trauma Treatment outcome Vitamin D Women Sydney New South Wales Australia Netherlands Belgium Australia
ISSN:	1932-6203, 1932-6203
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Abstract	Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed. In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models. Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49-0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64-0.97). Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality.
AbstractList	Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed. In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models. Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49-0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64-0.97). Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality. Objective Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed. Materials and methods In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models. Results Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49-0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64-0.97). Conclusion Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality. Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed. In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models. Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49-0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64-0.97). Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality. Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed.OBJECTIVEOsteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed.In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models.MATERIALS AND METHODSIn this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models.Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49-0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64-0.97).RESULTSThose recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49-0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64-0.97).Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality.CONCLUSIONOf the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality. Objective Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed. Materials and methods In this prospective cohort study, 5011 men and women aged >50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models. Results Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p < 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49–0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64–0.97). Conclusion Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality.
Audience	Academic
Author	Center, Jacqueline R. Dinant, Geert-Jan McLellan, Alastair R. van den Bergh, Joop P. W. van Geel, Tineke A. C. M. Geusens, Piet P. M. Bliuc, Dana Tran, Thach Eisman, John A.
AuthorAffiliation	University of Nevada Las Vegas, UNITED STATES 6 Clinical School, St Vincent's Hospital, Sydney, Australia 3 Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Research School CAPHRI, Maastricht, The Netherlands 10 Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, Australia 11 School of Medicine, University of Notre Dame Australia, Sydney, Australia 1 Department of Family Medicine, Maastricht University, Research School CAPHRI, Maastricht, The Netherlands 7 Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Research school NUTRIM, Maastricht, The Netherlands 2 Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia 5 Faculty of Medicine, University of New South Wales (UNSW) Sydney, Australia 8 Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands 9 Western Infirmary, Gardiner Insti
AuthorAffiliation_xml	– name: 8 Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands – name: 10 Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, Australia – name: University of Nevada Las Vegas, UNITED STATES – name: 2 Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia – name: 6 Clinical School, St Vincent's Hospital, Sydney, Australia – name: 5 Faculty of Medicine, University of New South Wales (UNSW) Sydney, Australia – name: 3 Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Research School CAPHRI, Maastricht, The Netherlands – name: 11 School of Medicine, University of Notre Dame Australia, Sydney, Australia – name: 9 Western Infirmary, Gardiner Institute, Glasgow, United Kingdom – name: 7 Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Research school NUTRIM, Maastricht, The Netherlands – name: 1 Department of Family Medicine, Maastricht University, Research School CAPHRI, Maastricht, The Netherlands – name: 4 Biomedical Research Institute, University Hasselt, Hasselt, Belgium
Author_xml	– sequence: 1 givenname: Tineke A. C. M. orcidid: 0000-0003-2022-6552 surname: van Geel fullname: van Geel, Tineke A. C. M. – sequence: 2 givenname: Dana surname: Bliuc fullname: Bliuc, Dana – sequence: 3 givenname: Piet P. M. surname: Geusens fullname: Geusens, Piet P. M. – sequence: 4 givenname: Jacqueline R. surname: Center fullname: Center, Jacqueline R. – sequence: 5 givenname: Geert-Jan surname: Dinant fullname: Dinant, Geert-Jan – sequence: 6 givenname: Thach surname: Tran fullname: Tran, Thach – sequence: 7 givenname: Joop P. W. surname: van den Bergh fullname: van den Bergh, Joop P. W. – sequence: 8 givenname: Alastair R. surname: McLellan fullname: McLellan, Alastair R. – sequence: 9 givenname: John A. surname: Eisman fullname: Eisman, John A.
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29856795$$D View this record in MEDLINE/PubMed
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DOI	10.1371/journal.pone.0198006
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DocumentTitleAlternate	Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Competing Interests: Dr. van Geel, Dr. Bliuc, Prof. Geusens, Prof. Dinant, dr. Tran, and Prof. McLellan have no competing of interests to report. Prof. Center discloses relevant financial interests outside this body of work. She has received honoraria for educational talks and meeting sponsorship from Amgen, Teva, and Merck Sharpe and Dohme. She has received honoraria for educational talks and meeting sponsorship from Amgen and Merck Sharpe and Dohme. Prof. van den Bergh discloses relevant financial interests outside this body of work. He has received honoraria for educational talks and grants from Amgen, Merck, Sharp and Dohme, Eli Lilly and Will Pharma. Prof. Eisman discloses relevant financial interests outside this body of work. He has received grants and/or personal fees from Amgen, Merck, Sharp and Dohme, Novartis, and sanofi-Aventis and non-financial support from Aspen. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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Snippet	Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third... Objective Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than... OBJECTIVE:Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than... Objective Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than...
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SubjectTerms	Administration, Oral Aged Alcohol use Analysis Biocompatibility Biology Biology and Life Sciences Biomedical materials Biomedical research Bisphosphonates Bone mineral density Calcium Care and treatment Cohort analysis Cohort Studies Confidence intervals Diphosphonates Diphosphonates - administration & dosage Diphosphonates - pharmacology Family medical history Female Fractures Fractures (Injuries) Fragility Health aspects Health risk assessment Health risks Hip Hospitals Humans Internal medicine Male Medical research Medicine Medicine and Health Sciences Men Middle Aged Mortality Mortality risk Older people Osteoporosis Osteoporotic Fractures - mortality Osteoporotic Fractures - prevention & control Patients Physical sciences Post-menopause Prospective Studies Public health Rheumatology Risk Risk factors Statistical models Trauma Treatment outcome Vitamin D Women
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Title	Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: A prospective cohort study
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Volume	13
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