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Effects of osteoporosis medications on bone fracture in patients with chronic kidney disease
  1. Chih-Chin Kao1,2,3,
  2. Pei-Chen Wu4,
  3. Ming-Tsang Chuang5,
  4. Shu-Ching Yeh1,3,
  5. Yen-Chung Lin1,2,3,
  6. Hsi-Hsien Chen1,2,3,
  7. Te-Chao Fang1,2,3,
  8. Wei-Chiao Chang6,7,
  9. Mai-Szu Wu2,3,8,
  10. Tzu-Hao Chang9,10
  1. 1Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
  2. 2Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  3. 3Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
  4. 4Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
  5. 5Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
  6. 6Department of Clinical Pharmacy, College of Medicine, Taipei Medical University, Taipei, Taiwan
  7. 7Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
  8. 8Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  9. 9Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
  10. 10Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
  1. Correspondence to Professor Tzu-Hao Chang, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; kevinchang{at}tmu.edu.tw; Professor Mai-Szu Wu, Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; maiszuwu{at}gmail.com

Abstract

Purpose of the study The risk of bone fracture is high in patients with chronic kidney disease (CKD), and aggressive treatment to reduce fragility fracture risk is the major strategy. However, the outcomes of osteoporosis medications in patients with CKD remain unclear.

Study design Patients with stage 3–5 CKD during 2011–2019 were enrolled. Patients were divided into two groups based on receiving osteoporosis medications (bisphosphonates, raloxifene, teriparatide or denosumab) or not. Two groups were matched at a 1:1 ratio by using propensity scores. The outcomes of interest were bone fractures, cardiovascular (CV) events and all-cause mortality. Cox proportional hazard regression models were applied to identify the risk factors. Additional stratified analyses by cumulative dose, treatment length and menopause condition were performed.

Results and conclusions 67 650 patients were included. After propensity score matching, 1654 patients were included in the study and control group, respectively. The mean age was 70.2±12.4 years, and 32.0% of patients were men. After a mean follow-up of 3.9 years, the incidence rates of bone fracture, CV events and all-cause mortality were 2.0, 1.7 and 6.5 per 1000 person-months, respectively. Multivariate analysis results showed that osteoporosis medications reduced the risk of CV events (HR, 0.35; 95% CI, 0.18 to 0.71; p=0.004), but did not alleviate the risks of bone fracture (HR, 1.48; 95% CI, 0.73 to 2.98; p=0.28) and all-cause mortality (HR, 0.93; 95% CI, 0.67 to 1.28; p=0.65). Stratified analysis showed that bisphosphonates users have most benefits in the reduction of CV events (HR, 0.26; 95% CI, 0.11 to 0.64; p=0.003). In conclusion, osteoporosis medications did not reduce the risk of bone fractures, or mortality, but improved CV outcomes in patients with CKD.

  • cardiology
  • kidney & urinary tract disorders
  • bone diseases

Data availability statement

Data are available upon reasonable request. The Taipei Medical University (TMU) only allows researchers to analyse the Taipei Medical University (TMU)-Affiliated Hospital Patient Profile Database, at the location within TMU. Currently, applications of this type have to be sent to the Taipei Medical University. There are at least requirements of an IRB approval and corresponding payment for using data.

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Data availability statement

Data are available upon reasonable request. The Taipei Medical University (TMU) only allows researchers to analyse the Taipei Medical University (TMU)-Affiliated Hospital Patient Profile Database, at the location within TMU. Currently, applications of this type have to be sent to the Taipei Medical University. There are at least requirements of an IRB approval and corresponding payment for using data.

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Footnotes

  • Contributors C-CK contributed to study concept and design; analysis and interpretation of data; drafting of the manuscript. P-CW contributed to analysis and interpretation of data; drafting of the manuscript. M-TC contributed to analysis and interpretation of data. S-CY contributed to revision of the draft. Y-CL contributed to interpretation of data. H-HC contributed to study concept and design. T-CF contributed to study concept and design; W-CC contributed to study concept and design. M-SW contributed to study concept and design T-HC contributed to study concept and design; final approval of the version to be published; responsible for the overall content, and acting as the guarantor.

  • Funding The study was supported by the funding and grants from Taiwan Ministry of Science and Technology (MOST 107-2314-B-038-019-MY3), Taipei Medical University (TMU109-AE1-B08), and Taipei Medical University Hospital (109TMU-TMUH-22).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.