Patients With Osteoporosis Can Live Long Lives

Troy Brown, RN

April 24, 2015

Women younger than 75 years and men under 60 years can expect to live at least 15 more years after beginning treatment for osteoporosis, according to a new observational study.

The results highlight the need for guidelines for the long-term management of patients with this condition, the researchers say.

Bo Abrahamsen, MD, PhD, from the Research Center for Aging and Osteoporosis, Glostrup Hospital, Denmark, and colleagues report their findings February 7 in the Journal of Bone and Mineral Research.

"We knew from a number of studies that patients with bone fractures due to osteoporosis have much increased risk of mortality, especially after a spine or hip fracture," Dr Abrahamsen told Medscape Medical News.

"My expectation was that patients on osteoporosis treatment would have reduced life expectancy, even with appropriate treatment, [because] the average age at the time of starting osteoporosis treatment in Denmark is about 70 years," he explained. So "the number of patients who had a life expectancy of 15-plus years was believed to be low," he added.

Long-Term Treatment Strategies Lacking

Osteoporosis is a common disease that causes two million fractures in the United States and 3.5 million in the European Union every year. It is widely accepted that patients with osteoporotic fractures experience increased mortality, but what is less clear is whether survival is affected in patients with osteoporosis who have not suffered a fracture.

"Long-term treatment of osteoporosis is challenging to the clinician, as long-term effects of our front-line osteoporosis drugs remain incompletely understood," the authors write.

"The competing risk of death may be a barrier to treating the oldest, yet this may not be rational if the risk of death is reduced by treatment. It is difficult to devise goal-directed long-term strategies for managing osteoporosis without firm information about residual lifetime expectancy in treated patients," they explain.

Outlook "Better in Women Than in Men"

To try to further inform this topic, the researchers used data from Danish national registries to track prescriptions for osteoporosis drugs, comorbid conditions, and deaths. They included 58,637 patients who began osteoporosis treatment from 1996 to 2003 and 225,084 control participants matched for age and gender. The researchers retrieved information on deaths through 2013, which allowed for a follow-up period of 10 to 17 years.

In men younger than 80 years and women younger than 60 years, the relative risk of death was strongly increased during the first year of treatment for osteoporosis relative to controls but then declined to a stable but elevated level in later years.

Women older than 65 to 70 years experienced only a small increase in mortality risk during the first year of treatment followed by a mortality risk similar to or lower than that in the control group.

The residual life expectancy was 18.2 years for men beginning osteoporosis treatment at age 50 years and 7.5 years for men beginning treatment at age 75 years. The residual life expectancy was 26.4 years and 13.5 years for women who began treatment at ages 50 years and 75 years, respectively.

"I was not surprised to find that patients with osteoporosis had increased mortality despite treatment, but it was reassuring to find that most patients who were treated for osteoporosis lived for 15 years or longer, although the outlook was a lot better in women than in men," Dr Abrahamsen told Medscape Medical News.

However, "we do not make inferences in this observational study as to whether excess mortality in osteoporosis was attenuated by medical treatment," he and his colleagues observe.

"Rather, the mortality in the study is a real-world observation that reflects the combined effect of disease and intervention."

Long-Term Guidelines "Are Only Just Being Developed"

"The present study shows that most of the patients we treat have a long life expectancy. We can't be complacent about the need for developing a long-term plan for osteoporosis treatment in each patient," Dr Abrahamsen said.

"Current treatment guidelines are fairly clear about the criteria for starting osteoporosis treatment, but the guidelines for pausing, ending, changing, or restarting treatment are only just being developed."

"This is a real challenge when we all meet a large number of patients who have already had treatment for 10 or 15 years," he concluded.

Dr Abrahamsen has received research grants from or served as an investigator in studies for Novartis, Nycomed/Takeda, NPS Pharmaceuticals, and Amgen. He has in the past served as a national advisory board member for Nycomed/Takeda, Merck, and Amgen and received speaker's fees from Nycomed/Takeda, Amgen, Merck, and Eli Lilly. Disclosures for the coauthors are listed in the article.

J Bone Miner Res. Published online February 7, 2015. Abstract


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