A new international study has explored how different bone-strengthening medications affect people after they suffer a hip fracture.
The study was led by researchers at Monash University’s Centre for Medicine Use and Safety (CMUS) and published in the journal Osteoporosis International.
The researchers wanted to understand how two common types of osteoporosis medicines—bisphosphonates and denosumab—affect the chances of having another fracture or dying after a first hip fracture. To do this, they studied people in four countries: Australia, Hong Kong, Taiwan, and the United Kingdom.
They looked at thousands of patients who had been given either bisphosphonates or denosumab after their first hip fracture. They then compared the risk of having another fracture or dying.
The results showed that people taking bisphosphonates were 25% more likely to have another fracture than those taking denosumab. However, men who took bisphosphonates had a lower chance of dying than men who took denosumab. This sex-related difference was unexpected and raises new questions for future research.
Another important part of the study focused on people with dementia or frailty. These individuals are at high risk of breaking another bone, but they are often not given bone-strengthening medications.
The researchers found that both types of medication—bisphosphonates and denosumab—worked similarly in people with or without dementia. This finding suggests that people with dementia can benefit just as much from these treatments as those without dementia.
Dr. Jenni Ilomaki, the study’s lead author, said they aimed to understand the risks of future fractures and death in patients with dementia and frailty who were given these medications. She noted that while both medications were generally effective, the unexpected difference in men’s survival rates needs to be studied further.
Professor Simon Bell, senior author and director of CMUS, explained that their research is crucial because many people who break a hip also have dementia. In fact, 1 in 5 people with a hip fracture also have dementia, and these individuals are at higher risk of a second fracture and of dying after the fracture.
Unfortunately, people with dementia are often less likely to receive treatment for osteoporosis, even though the risk is higher for them. The study’s authors believe that this is a major gap in medical care that needs to be addressed.
Clinical guidelines for osteoporosis don’t usually offer specific advice for treating people with dementia or frailty, which leaves doctors uncertain about what is best.
Professor Bell also pointed out that people with dementia are more likely to fall and hurt themselves. Previous research has shown that the chance of having a second hip fracture is twice as high in people with dementia compared to those without.
In conclusion, this study shows that both bisphosphonates and denosumab can help prevent further bone damage after a hip fracture, including in people with dementia.
However, the medications work differently depending on sex, and many people with dementia still aren’t getting the treatment they need. More research is needed to guide doctors on how to best treat these patients. This study is a step forward, but it also highlights the need for clearer and more inclusive medical guidelines.
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