Meta-analysis questions use of osteoporosis treatments to reduce mortality risk
medwireNews: Findings from a meta-analysis published in JAMA Internal Medicine indicate that drug treatments for osteoporosis, particularly bisphosphonates, are not associated with a significant reduction in overall mortality risk.
Therefore drug treatments “should be recommended only for the prevention of fracture and not for any additional reduction in mortality” among patients with osteoporosis, say Steven Cummings (San Francisco Coordinating Center, California, USA) and fellow researchers.
The meta-analysis included 38 randomized placebo-controlled trials involving a total of 101,642 individuals, of whom 56,048 were treated with a pharmacologic therapy for osteoporosis while 45,594 were given placebo.
There was no significant difference in mortality rates among patients given an osteoporosis drug versus placebo, neither when all drugs were evaluated together (rate ratio [RR]=0.98) nor when the analysis was restricted to 21 trials of bisphosphonate treatments (RR=0.95).
Similarly, mortality rates were not significantly different among patients treated with zoledronate compared with placebo in six randomized trials, but Cummings et al note that “there was evidence for heterogeneity of the results.”
They say: “More data from placebo-controlled clinical trials of zoledronate therapy and mortality rates are needed to resolve whether treatment with zoledronate is associated with reduced mortality in addition to decreased fracture risk.”
The investigators note that their findings contradict the results of some observational studies suggesting a 25–60% decrease in mortality risk with drug treatment, a reduction that is “too large to be owing to a decrease in fracture risk.”
The current findings “suggest that observational studies reporting that patients receiving bisphosphonate therapy had lower mortality may not have measured confounding factors that may have contributed to lower mortality [risk],” they say.
Cummings and colleagues note, however, that their study “did not exclude the possibility that decreasing the risk of fractures may be associated with reducing the mortality caused by those fractures.”
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