Associations between use of anti-resorptive agents for patients with osteoporosis and all-cause mortality risk: a nationwide population-based study

초록

Although the association between osteoporosis-related fractures and mortality is well-established, it remains uncertain whether osteoporosis drug treatments reduce the risk of mortality. Therefore, we investigated to determine the association between anti-resorptive agents and mortality risk in postmenopausal women with osteoporosis. A total of 117,871 women who diagnosed as osteoporosis by dual-energy X-ray absorptiometry screening were included from the National Screening Program for Transitional Ages health examination from 2008 to 2017. Among them, 11,337 patients who had taken anti-resorptive agents (AR), either bisphosphonate or selective estrogen receptor modulator (SERM), for at least 1 year (AR user group) were matched at a 1:1 ratio to those who had never taken osteoporotic agents (non-user group) by using propensity scores. We estimated the risk of allcause mortality using multivariable Cox proportional hazard regression models. The mean age of women was 66 years and mean body mass index was 23.2 +/-3.0 kg/m2. In the AR user group, 73.8% was prescribed with bisphosphonates, whereas 26.2% was treated with SERMs. During a median follow-up period of 1.6 years, a total of 121 deaths occurred in the AR user group, and 201 deaths occurred in the non-user group. The mortality rate was 1.99 deaths per 1000 person-years in AR users and 3.36 deaths in non-users, which corresponded to a 45% lower mortality rate in AR users (HR, 0.55; 95% CI, 0.44-0.69). Furthermore, the longer the individuals took AR, the lower the risk of all-cause mortality compared to the control group [HR = 0.55 in 12-24 months, HR = 0.55 in 24-36 months, and HR = 0.50 in >=36 months, p-for trend <0.01]. The mortality risk related to cardiovascular disease (CVD) was lower in the AR group compared to the non-user group (HR = 0.72; 95% CI: 0.64-0.81); however, the interpretation should be approached with caution due to the limited number of events. In the subgroup analysis, the use of AR-related to reduced mortality was more prominent in the calcium or vitamin D replete group compared to the non-replete groups (p for trend <0.001 for both). Taking AR agents contributed to lowering risk of all-cause mortality among postmenopausal women with osteoporosis. Our findings provided real-world evidence regarding the necessity of management of osteoporosis with anti-osteoporotic agents in postmenopausal women.