Effectiveness of Antiresorptive Medications in Women on Long-term Dialysis After Hip Fracture: A Population-based Cohort Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Sep 3

PMID 32877436

Authors

Yu-Ciou Lin

Tien-Ching Lee

Chung-Yu Chen

Shun-Jin Lin

Shang-Jyh Hwang

Ming-Yen Lin

Affiliations

Soon will be listed here.

Abstract

There is no clear evidence how effective the antiresorptive (AR) drugs alendronate and raloxifene are at reducing risk of second hip fracture and mortality in dialysis populations. The purpose of this study was to compare the risk of hospitalization for second hip fracture and risk of mortality between AR user and non-user groups in Taiwanese women on long-term dialysis with hip fractures. We conducted a retrospective cohort study using Taiwan National Health Insurance Research Datasets. Long-term dialysis women older than 50 years with newly diagnosed hip fractures and new to AR therapy from 2005 to 2011 were recruited. The patients were divided into AR users and non-users and matched by propensity score. We used Cox Proportional Hazards models to assess association of AR with risks of second hip fracture and mortality. Totally, 1,079 dialysis patients were included, and after matching, we were left with 74 AR users and 74 non-users. AR users did not show a significant reduction in the incidence of second hip fracture compared with non-users (adjusted Hazard Ratio (HR): 0.91, 95% CI: 0.30-2.76), and alendronate users exhibited higher risk of second hip fracture compared with raloxifene users (adjusted HR: 2.80, 95% CI: 0.42-18.79). In addition, AR users were found to have significantly lower 1- and 2-year mortality rates than the non-users (1- year: adjusted HR 0.25, 95% CI, 0.07-0.90; 2-year: 0.35, 95%CI: 0.17-0.72). AR treatment did not significantly improve the risk of second hip fracture but significantly reduce mortality in older women on dialysis. Further clinical trials on effectiveness of AR medications for dialysis populations should be warranted.

References

Barrett-Connor E, Grady D, Sashegyi A, Anderson P, Cox D, Hoszowski K . Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA. 2002; 287(7):847-57. DOI: 10.1001/jama.287.7.847. View

Li L, Roddam A, Gitlin M, Taylor A, Shepherd S, Shearer A . Persistence with osteoporosis medications among postmenopausal women in the UK General Practice Research Database. Menopause. 2011; 19(1):33-40. DOI: 10.1097/gme.0b013e318221bacd. View

Grady D, Cauley J, Stock J, Cox D, Mitlak B, Song J . Effect of Raloxifene on all-cause mortality. Am J Med. 2010; 123(5):469.e1-7. DOI: 10.1016/j.amjmed.2009.12.018. View

Siris E, Harris S, Rosen C, Barr C, Arvesen J, Abbott T . Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc. 2006; 81(8):1013-22. DOI: 10.4065/81.8.1013. View

Saito O, Saito T, Asakura S, Sugase T, Ito C, Ando Y . The effects of raloxifene on bone turnover markers and bone mineral density in women on maintenance hemodialysis. Clin Exp Nephrol. 2010; 15(1):126-31. DOI: 10.1007/s10157-010-0366-0. View

Ott S . Bisphosphonate safety and efficacy in chronic kidney disease. Kidney Int. 2012; 82(8):833-5. DOI: 10.1038/ki.2012.253. View

Wetmore J, Benet L, Kleinstuck D, Frassetto L . Effects of short-term alendronate on bone mineral density in haemodialysis patients. Nephrology (Carlton). 2005; 10(4):393-9. DOI: 10.1111/j.1440-1797.2005.00436.x. View

Lima G, Paranhos Neto F, Pereira G, Gomes C, Farias M . Osteoporosis management in patient with renal function impairment. Arq Bras Endocrinol Metabol. 2014; 58(5):530-9. DOI: 10.1590/0004-2730000003360. View

. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001; 285(6):785-95. DOI: 10.1001/jama.285.6.785. View

10.

Saito O, Saito T, Asakura S, Akimoto T, Inoue M, Ando Y . Effects of raloxifene on bone metabolism in hemodialysis patients with type 2 diabetes. Int J Endocrinol Metab. 2013; 10(2):464-9. PMC: 3693610. DOI: 10.5812/ijem.3794. View

11.

Price P, Faus S, Williamson M . Bisphosphonates alendronate and ibandronate inhibit artery calcification at doses comparable to those that inhibit bone resorption. Arterioscler Thromb Vasc Biol. 2001; 21(5):817-24. DOI: 10.1161/01.atv.21.5.817. View

12.

Granger B, Swedberg K, Ekman I, Granger C, Olofsson B, McMurray J . Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial. Lancet. 2005; 366(9502):2005-11. DOI: 10.1016/S0140-6736(05)67760-4. View

13.

Cai G, Keen H, Host L, Aitken D, Laslett L, Winzenberg T . Once-yearly zoledronic acid and change in abdominal aortic calcification over 3 years in postmenopausal women with osteoporosis: results from the HORIZON Pivotal Fracture Trial. Osteoporos Int. 2020; 31(9):1741-1747. DOI: 10.1007/s00198-020-05430-z. View

14.

Goldshtein I, Rouach V, Shamir-Stein N, Yu J, Chodick G . Role of Side Effects, Physician Involvement, and Patient Perception in Non-Adherence with Oral Bisphosphonates. Adv Ther. 2016; 33(8):1374-84. DOI: 10.1007/s12325-016-0360-3. View

15.

Hernandez E, Valera R, Alonzo E, Bajares-Lilue M, Carlini R, Capriles F . Effects of raloxifene on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis. Kidney Int. 2003; 63(6):2269-74. DOI: 10.1046/j.1523-1755.2003.00005.x. View

16.

Ettinger B, Black D, Mitlak B, Knickerbocker R, Nickelsen T, Genant H . Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999; 282(7):637-45. DOI: 10.1001/jama.282.7.637. View

17.

Ariyoshi T, Eishi K, Sakamoto I, Matsukuma S, Odate T . Effect of etidronic acid on arterial calcification in dialysis patients. Clin Drug Investig. 2006; 26(4):215-22. DOI: 10.2165/00044011-200626040-00006. View

18.

Barrett-Connor E, Mosca L, Collins P, Geiger M, Grady D, Kornitzer M . Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med. 2006; 355(2):125-37. DOI: 10.1056/NEJMoa062462. View

19.

Brozek W, Reichardt B, Zwerina J, Dimai H, Klaushofer K, Zwettler E . Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: a nationwide study. Osteoporos Int. 2015; 27(1):387-96. DOI: 10.1007/s00198-015-3415-4. View

20.

Jager K, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C . A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019; 34(11):1803-1805. DOI: 10.1093/ndt/gfz174. View