
How drug treatments impact osteoporosis and mortality rates
For patients with osteoporosis, drug treatments with bisphosphonates may not reduce overall mortality rates, according to a meta-analysis from JAMA Internal Medicine.
For patients with osteoporosis, drug treatments with bisphosphonates, particularly zoledronate, may not reduce overall mortality rates, according to a
Methods
The investigators searched
Of the 2,045 records screened, only 1.8% were included in the meta-analysis. The four inclusion criteria were clinical trials that were randomized, double-blind and placebo-controlled; drug treatments with proven antifracture efficacy; agents used at the approved dose for treatment of osteoporosis; and study duration of at least 1 year.
Findings
No significant connection was found between all drug treatments for osteoporosis and overall mortality rate: risk ratio (RR) = 0.98; 95% confidence interval (CI): 0.91 to 1.05 (I2 = 0%). Clinical trials of bisphosphonate treatment also showed no significant association with overall mortality: RR = 0.95; 95% CI: 0.86 to 1.04. The same relationship held true for zoledronate treatment as well: RR = 0.88; 95% CI: 0.68 to 1.13. However, there was evidence for heterogeneity of the overall results: I2 = 48.2%.
A prior
But the current larger analysis found “no significant association between the mortality rates in the placebo groups of the clinical trials and the association of treatment with mortality for all drug treatments,” the authors wrote. There was less certainty, though, for the association between intravenous zoledronate treatment and mortality rates because of the heterogeneous results of the clinical trials. Specifically, two large studies of zoledronate treatment found 28% and 35% reductions in mortality, respectively, which were not observed in other clinical trials.
Similarly, observational studies reported 25% to 60% reductions in total mortality rates, which were too great of a reduction to attribute to a decrease in fracture risk. “Therefore, the reduced mortality rates would likely be owing to the direct biological effects of these treatments rather than the reduced fracture risk,” the authors wrote. In addition, observational studies of patients receiving bisphosphonate therapy who had lower mortality may not have measured confounding factors that could have contributed to this lower mortality.
Conclusions
The apparent reduction in mortality may be the power of the placebo effect, for which the authors cite a
The authors said additional studies are needed to elucidate whether treatment with zoledronate reduces mortality rates in patients with osteoporosis.
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