Effectiveness of Bisphosphonates in Young Adults with Fragility Fractures: Representative Population-Based Cohort Study

Sung Hye Kong; Ju-Young Park; Moon-Kyung Shin; Hyo-Jung Lee; Jin Woo Kim; Seung Shin Park; Sang Wan Kim; Chan Soo Shin; Tae-Jin Song

doi:10.1210/clinem/dgae850

Effectiveness of Bisphosphonates in Young Adults with Fragility Fractures: Representative Population-Based Cohort Study

J Clin Endocrinol Metab. 2024 Dec 6:dgae850. doi: 10.1210/clinem/dgae850. Online ahead of print.

Authors

Sung Hye Kong^{1

2}, Ju-Young Park^{3

4}, Moon-Kyung Shin⁵, Hyo-Jung Lee⁶, Jin Woo Kim⁷, Seung Shin Park⁸, Sang Wan Kim^{2

9}, Chan Soo Shin^{2

8}, Tae-Jin Song¹⁰

Affiliations

¹ Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam.
² Department of Internal Medicine, Seoul National University College of Medicine, Seoul.
³ Department of Applied Statistics, Yonsei University, Seoul.
⁴ Department of Statistics and Data science, Yonsei University, Seoul.
⁵ Medical Research Institute, Ewha Womans University, College of Medicine, Seoul.
⁶ Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam.
⁷ Department of Oral and Maxillofacial Surgery, Research Institute for Intractable Osteonecrosis of the Jaw, Ewha Womans University College of Medicine, Seoul.
⁸ Department of Internal Medicine, Seoul National University Hospital, Seoul.
⁹ Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul.
¹⁰ Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul.

PMID: 39657239
DOI: 10.1210/clinem/dgae850

Abstract

Context: Fragility fractures in young adults present significant clinical challenges due to the limited evidence on the effectiveness of bisphosphonates in preventing subsequent fractures.

Objective: To evaluate the effectiveness of bisphosphonate therapy in reducing the fracture risk among premenopausal women with a history of osteoporotic fractures.

Design: A population-based retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in South Korea, covering the years 2003 to 2014.

Setting: A nationwide healthcare setting utilizing a representative cohort database.

Participants: Among 2,087 premenopausal women with osteoporotic fractures, participants were propensity score-matched based on age and body mass index at a 1:3 ratio, resulting in 132 bisphosphonate users and 396 non-users.

Intervention: Bisphosphonate treatment.

Main outcome measures: The incidence of osteoporotic fractures.

Results: Bisphosphonate users had a significantly lower risk of major osteoporotic fractures (HR 0.618, 95% CI 0.396 - 0.963) compared to non-users. Ibandronate users showed significant reductions in both major osteoporotic (HR 0.376, 95% CI 0.164 - 0.861) and nonvertebral fractures (HR 0.214, 95% CI 0.052 - 0.877). Also, longer duration of bisphosphonate use (≥180 days) was associated with a significantly lower risk of major osteoporotic and nonvertebral fractures (HR 0.528, 95% CI 0.300 - 0.929; HR 0.409, 95% CI 0.187 - 0.895, respectively).

Conclusions: Bisphosphonate therapy significantly reduces fracture risk in premenopausal women with previous osteoporotic fractures, especially at higher cumulative doses. These findings support considering bisphosphonates as a treatment option in premenopausal women at high risk of fractures.

Keywords: Bisphosphonates; Effectiveness; Fractures; Young Adults.

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