A new international study led by Monash University’s Centre for Medicine Use and Safety (CMUS) has found that men and women may respond differently to common bone-strengthening medications following a hip fracture. The research, published in Osteoporosis International, examined the risks of second hip fractures, other subsequent fractures, and mortality in patients prescribed two types of osteoporosis treatments.
The study analyzed population-based data from Australia, Hong Kong, Taiwan, and the United Kingdom, comparing outcomes for patients prescribed bisphosphonates versus denosumab after their first hip fracture.
Overall, patients taking bisphosphonates experienced a 25% higher rate of subsequent fractures compared with those taking denosumab. However, men on bisphosphonates had a lower rate of death than men taking denosumab.
The study also found that people with or without dementia benefited similarly from both medications. This is particularly significant because patients with dementia or frailty are often under-treated with bone-strengthening drugs despite their elevated risk of further fractures.
Associate Professor Jenni Ilomaki, CMUS and lead author of the study, said: “We investigated fracture and mortality risks in people with dementia and frailty prescribed bisphosphonates or denosumab. We found no major differences in treatment outcomes based on dementia or frailty status, but we did observe an unexpected sex-related difference.”
“Our hope is that this study provides a foundation for more informed prescribing practices in the future.”
Professor Simon Bell, CMUS director and senior author, emphasized the lack of research on the effectiveness of first-line osteoporosis treatments in patients with dementia or frailty. “One in five hip fracture patients has dementia, yet these patients are less likely to receive treatment and face higher risks of second fractures and post-fracture mortality,” he said.
The authors, experts in safe and effective medication use in older adults, stress the need for further research on osteoporosis treatment in patients with dementia or frailty. Professor Bell added, “Fall-related injuries are common in people with dementia, and the risk of a second hip fracture is twice as high compared to those without dementia. Despite this, most clinical guidelines do not provide specific recommendations for treating osteoporosis in these high-risk groups—a gap that must be addressed.”
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