Taking Osteoporosis Drugs Can Reduce Premature Mortality Risk by Up to 39%
Osteoporosis is a disease where the bones become more porous and fragile, which dramatically increases the risk of bone fractures. It affects about 200 million people worldwide, is a progressive disease, and there are often are no symptoms until a fracture.
“It’s a common misconception that osteoporosis affects only women, and many people choose to not take recommended treatments,” stated Jacqueline Center, who runs the Clinical Studies and Epidemiology laboratory at the Garvan Institute and is an endocrinologist at St. Vincent’s Hospital. Center led the studies.
Center added, “But osteoporotic fractures are not benign. Osteoporosis medication not only decreases the risk of further fractures—but it appears that this same medication also decreases mortality rates over the subsequent 15 years.”
The international research team analyzed data from 6,120 people over the age of 50 who participated in the observational Canadian Multicentre Osteoporosis Study. They found that people treated with nitrogen-bisphosphonates (alendronate or risedronate) had a 34% decrease in mortality risk over the subsequent 15 years compared to people who were untreated. The research was published in the journal Osteoporosis International.
Denosumab is Amgen’s Prolia. Alendronate was originally marketed as Merck’s Fosamax.
The authors note that accelerated bone loss is by itself is an independent predictor of mortality risk, but until this point, the associate between bisphosphonates, bone loss and mortality was unknown.
They published a follow-up study in the Journal of Bone and Mineral Research. This research looked at 1,735 women, from the same study. It found that 39% of the decrease in premature mortality risk was related to the reduction in the rate of bone loss.
In addition to baseline bone mineral density (BMD) values, the study tracked comorbidities and lifestyle factors at baseline and at years three, five and 10.
Bisphosphonate patients were grouped into nitrogen bisphosphonates, such as alendronate or risedronate, and etidronate and non-users.
Rapid bone loss was associated with more than a two-fold increased mortality risk compared to patients with no rapid bone loss.
“For many individuals with osteoporosis, bone health isn’t front-of-mind,” stated first author of both studies, Garvan’s Dana Bliuc, research officer in the Clinical Studies and Epidemiology laboratory. “We hope our study results will encourage people with osteoporosis or at risk of a fracture to seek treatment—and commit to taking it.”
After the age of 50, about 40% of women and 25% of men will have an osteoporosis-related fracture in their life. This also places them at increased risk of more fractures. Studies have found that only 30% of women and 20% of men with fragility fractures take approved osteoporosis treatments.
In April, the U.S. Food and Drug Administration (FDA) approved Amgen and UCB’s Evenity (romosozumab-aqqg) for osteoporosis in postmenopausal women at high risk for fracture. The drug had been rejected in 2017 over safety concerns. Evenity was approved by two Phase III clinical trials. In the FRAME Trial, treatment with Evenity showed a significant decrease in new spine fracture at 12 months compared to placebo. The reduction in fracture risk remained through the second year in women who received the drug during the first year and transitioned to denosumab compared to those who transitioned from placebo to denosumab.
In the ARCH trial, patients received Evenity for a year followed by 12 months of alendronate. This significantly decreased the incidence of new spinal fracture at 24 months and also significantly reduced the risk of clinical fracture after a median follow-up of 33 months.
Denosumab is Amgen’s Prolia, which is prescribed for osteoporosis in women after menopause who are at high risk for fractures or who can’t use another osteoporosis drug, or the other drugs did not work well. It is intended for chronic treatment, while Evenity is intended for short-term use.