Bisphosphonate treatment is associated with decreased mortality rates in patients after osteoporotic vertebral fracture

Summary The aim of this study is to investigate the effect of bisphosphonate (BP) on mortality after osteoporotic vertebral fracture (OVF). BP medication (hazard ratios = 0.593; 95%CI: 0.361–0.976) was significantly associated with reduced all-cause mortality after OVF. Purpose Osteoporotic vertebral fracture (OVF) is the most common type of fragility fracture. Bisphosphonate (BP) medication was suggested to have positive effects on both fracture prevention and recovery outcomes. The aim of this study is to investigate the effect of BP on mortality after OVF. Methods This cohort study involved 535 patients (170 males and 365 females), aged ≥ 65 years (mean age: 82.6 ± 7.0 years, mean follow-up periods: 33.0 ± 25.8 months) who were hospitalized after OVF from January 2011 to December 2019 at a public hospital. Patients treated with PTH (parathyroid hormone), PTH or PTHrp analogues, denosumab, and selective estrogen receptor modulators were excluded. Kaplan–Meier survival curves on mortality of patients with OVF with and without BP treatment were prepared, and log-rank tests were performed. Cox proportional hazards model was used to identify factors associated with mortality after OVF. Results This study included 163 (30.5%) patients treated with BP. Kaplan–Meier survival curves showed that the mortality rate after OVF was significantly lower in patients treated with BP ( P < 0.001). Cox proportional hazards model showed that older age (hazard ratios [HR] = 1.066; 95%CI:1.035–1.103), male sex (HR = 2.248; 95%CI:1.427–3.542), malnutrition (geriatric nutritional risk index < 92) (HR = 1.691; 95%CI:1.005–2.846), BP medication (HR = 0.593; 95%CI: 0.361–0.976), and Japanese Orthopaedic Association score at discharge (HR = 0.941; 95%CI: 0.892–0.993) were significantly associated with all-cause mortality after OVF. Conclusions BP medication is beneficial not only for fracture prevention but also for mortality after OVF.