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Disclosure belangen NHG spreker (Potentiële) belangenverstrengeling None Voor bijeenkomst mogelijk relevante relaties met bedrijven Sponsoring of onderzoeksgeld Honorarium of andere (financiële) vergoeding Aandeelhouder Andere relatie, namelijk …

Reduced mortality and subsequent fracture risk associated with oral bisphosphonate treatment Tineke van Geel Dana Bliuc, Piet Geusens, Jacqueline Center, Geert-Jan Dinant, Thach Tran, Joop vd Bergh, Alastair McLellan, John A Eisman

Background Initial fracture increases risk of subsequent fracture and mortality Secondary fracture prevention is endorsed by national guidelines Rising call for implementing fracture liaison services (FLS) To analyze the effect of oral bisphosphonate (BP) therapy on subsequent fracture and mortality over 8-years of follow-up

Methods FLS of West-Glasgow health service 1999-2007, men & women ≥ 50 invited Independent T-test and Chi-square test for comparing baseline characteristics Uni- and multivariable Cox proportional Hazard models Endpoints: subsequent fracture & mortality Time to fracture & death; censored at 8 years

5011 (53.1) fully assessed; all recommended CaD 9439 patients ≥ 50 yrs (1999-2007) 0509 (5.4)0 reviewed 1822 (19.3) frail elderly 2097 (22.2) declined 5011 (53.1) fully assessed; all recommended CaD No additional treatment 2477 (49.4%) + oral bisphosphonates 2534 (50.6%) 293(11.8) re-fx 235 (9.5) deceased 336 (13.3) re-fx 381 (15.0) deceased P = 0.126 P < 0.001

Patients on BP had worse baseline characteristics CaD alone + BP Women, % 72.4 82.9 Age, years 64.4 73.4 BMD, T-score -1.5 -3.1 Initial hip fx, % 6.2 21.2 P < 0.001 Patients on BP had worse baseline characteristics

Univariable model: Predictors for subsequent fractures and mortality Gender Age BMD Fracture location Smoking Glucocorticoid use Alcohol intake ≥ 5 units per day Bisphosphonates

Subsequent fractures HR: 1.17 (1.00-1.36) HR: 0.60 (0.49-0.73) + BP CaD alone Subsequent fractures Univariable Multivariable HR: 1.17 (1.00-1.36) P = 0.056 HR: 0.60 (0.49-0.73) P < 0.001 background methods results conclusion

Mortality HR: 1.64 (1.40-1.93) HR: 0.79 (0.64-0.96) + BP CaD alone Univariable Multivariable HR: 1.64 (1.40-1.93) P < 0.001 HR: 0.79 (0.64-0.96) P = 0.021 background methods results conclusion

Conclusion Patients recommended bisphosphonates had worse baseline characteristics After adjustments, those on BP had a lower hazard for Subsequent fracture Mortality

Thank you for your attention! tineke.vangeel@maastrichtuniversity.nl