ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2019
Bisphosphonates and mortality: confounding in observational studies?
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cardiovascular Safety and Effectiveness of Bisphosphonates: From Intervention Trials to Real-Life Data.Nutrients · 2022Pooled it
- Fracture and mortality outcomes by osteoporosis treatment route in patients with type 2 diabetes and obesity: a propensity-matched registry study.Frontiers in endocrinology · 2026Article
- Bisphosphonate Use and Reduced All-Cause Mortality in Korean Women Older than 50 Years: A Nationwide Sample Cohort Study.Journal of bone metabolism · 2025Article
- From Bone Health to Lifespan: Pleiotropic Effects of Antiresorptive Agents.Endocrinology and metabolism (Seoul, Korea) · 2025Review
- Treatment Considerations for Severe Osteoporosis in Older Adults.Drugs & aging · 2025Review
- Review
- Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
- Bisphosphonate-based hydrogel mediates biomimetic negative feedback regulation of osteoclastic activity to promote bone regeneration.Bioactive materials · 2022Article
- Real-World Effectiveness of Anti-Resorptive Treatment in Patients With Incident Fragility Fractures-The STORM Cohort-A Swedish Retrospective Observational Study.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Observational
- All-cause mortality risk in aged femoral intertrochanteric fracture patients.Journal of orthopaedic surgery and research · 2021Article
- Adherence to Anti-Osteoporotic Treatment and Clinical Implications after Hip Fracture: A Systematic Review.Journal of personalized medicine · 2021Review
- Correction to: Bisphosphonates and mortality: confounding in observational studies.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- Common methodological issues and suggested solutions in bone research.Osteoporosis and sarcopenia · 2020Review
- Article
- Benefits of Bisphosphonate Therapy: Beyond the Skeleton.Current osteoporosis reports · 2020Review
- Article
- The interplay between bone and heart health as reflected in medication effects: A narrative review.Women's health (London, England)Review
Corrections and comments
- Erratum issued
Authors and funding
5 authors.
Funding
Abstract
Numerous observational studies suggest that bisphosphonates reduce mortality. This study showed that bisphosphonate use is associated with lower mortality within days of treatment, although the association was not significant until the second week. Such an early association is consistent with confounding, although an early treatment effect cannot be ruled out.
introductionThe purpose of this study was to examine whether confounding explains why numerous observational studies show that bisphosphonate use is associated with lower mortality. To this end, we examined how soon after treatment initiation a lower mortality rate can be observed. We hypothesized that, due to confounding, the association would be observed immediately.
methodsThis was a retrospective cohort study of hip fracture patients discharged from Swedish hospitals between 1 July 2006 and 31 December 2015. The data covered 260,574 hip fracture patients and were obtained from the Swedish Hip Fracture Register and national registers. Of the 260,574 patients, 49,765 met all eligibility criteria and 10,178 were pair matched (bisphosphonate users to controls) using time-dependent propensity scores. The matching variables were age, sex, diagnoses, prescription medications, type of hip fracture, type of surgical procedure, known or suspected dementia, and physical functioning status.
resultsOver a median follow-up of 2.8 years, 2922 of the 10,178 matched patients died. The mortality rate was 7.9 deaths per 100 person-years in bisphosphonate users and 9.4 deaths in controls, which corresponded to a 15% lower mortality rate in bisphosphonate users (hazard ratio 0.85, 95% confidence interval 0.79-0.91). The risk of death was lower in bisphosphonate users from day 6 of treatment, although the association was not significant until the second week.
conclusionBisphosphonate use was associated with lower mortality within days of treatment initiation. This finding is consistent with confounding, although an early treatment effect cannot be ruled out.
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