Osteoporosis treatment prevents hip fracture similarly in both sexes: the FOCUS observational study

Author:

Keaveny Tony M1ORCID,Adams Annette L2ORCID,Orwoll Eric S3ORCID,Khosla Sundeep4ORCID,Siris Ethel S5ORCID,McClung Michael R6ORCID,Bouxsein Mary L78ORCID,Fatemi Shireen9,Lee David C10ORCID,Kopperdahl David L10ORCID

Affiliation:

1. Departments of Mechanical Engineering and Bioengineering, University of California , Berkeley, CA 94720, United States

2. Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, CA 91101, United States

3. Bone and Mineral Unit, Oregon Health & Science University , Portland, OR 97239, United States

4. Division of Endocrinology, Kogod Center on Aging, Mayo Clinic , Rochester, MN 55905, United States

5. Department of Medicine, Toni Stabile Osteoporosis Center, Columbia University Medical Center , New York, NY 10032, United States

6. Oregon Osteoporosis Center , Portland, OR 97225, United States

7. Department of Orthopedic Surgery , Harvard Medical School, , Boston, MA 02215, United States

8. Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center , Harvard Medical School, , Boston, MA 02215, United States

9. Department of Endocrinology, Kaiser Permanente Southern California , Panorama City, CA 91402, United States

10. O.N. Diagnostics LLC , Berkeley, CA 94704, United States

Abstract

Abstract Randomized trials have not been performed, and may never be, to determine if osteoporosis treatment prevents hip fracture in men. Addressing that evidence gap, we analyzed data from an observational study of new hip fractures in a large integrated healthcare system to compare the reduction in hip fractures associated with standard-of-care osteoporosis treatment in men versus women. Sampling from 271,389 patients aged ≥ 65 who had a hip-containing CT scan during care between 2005 and 2018, we selected all who subsequently had a first hip fracture (cases) after the CT scan (start of observation) and a sex-matched equal number of randomly selected patients. From those, we analyzed all who tested positive for osteoporosis (DXA-equivalent hip BMD T-score ≤ −2.5, measured from the CT scan using VirtuOst). We defined “treated” as at least six months of any osteoporosis medication by prescription fill data during follow-up; “not-treated” was no prescription fill. Sex-specific odds ratios of hip fracture for treated vs not-treated patients were calculated by logistic regression; adjustments included age, BMD T-score, BMD-treatment interaction, BMD, race/ethnicity, and seven baseline clinical risk factors. At two-year follow-up, 33.9% of the women (750/2,211 patients) and 24.0% of the men (175/728 patients) were treated primarily with alendronate; 51.3% and 66.3%, respectively, were not-treated; and 721 and 269, respectively, had a first hip fracture since the CT scan. Odds ratio of hip fracture for treated vs not-treated was 0.26 (95% confidence interval: 0.21–0.33) for women and 0.21 (0.13–0.34) for men; the ratio of these odds ratios (men:women) was 0.81 (0.47–1.37), indicating no significant sex effect. Various sensitivity and stratified analyses confirmed these trends, including results at five-year follow-up. Given these results and considering the relevant literature, we conclude that osteoporosis treatment prevents hip fracture similarly in both sexes.

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

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