Bisphosphonates cut fracture risk in older cirrhosis patients

Older patients with cirrhosis who are taking bisphosphonates appear to have a reduced incidence of fractures overall, according to a study.

Researchers used national Medicare data (2008–2020) to examine the 5-year risk of fractures in relation to the use of bisphosphonates, with a new-user design among people diagnosed with cirrhosis and osteoporosis. Bisphosphonate-treated and untreated patients were balanced using inverse probability of treatment weighting.

Intention-to-treat and as-treated effects were evaluated, and both control exposures (statin use) and outcomes (decompensation) were examined to test causal relationships.

The study population comprised 253 new users of bisphosphonates and 20,888 nonusers. Their median age was 74 years. Alendronate was the most common bisphosphonate used (73.6 percent).

In the intention-to-treat analysis, bisphosphonates were significantly associated with reduced fractures overall (27.5 percent vs 33.0 percent; p=0.0004). This benefit was observed in people who were <65 years of age (subdistribution hazard ratio [sHR], 0.56), men (sHR, 0.64), and those with nonalcohol-related liver disease (sHR, 0.85).

Bisphosphonate users vs nonusers had fewer arm (20.7 percent vs 26.4 percent; p<0.0001) and femur (28.9 percent vs 31.2 percent; p=0.005) fractures but more spinal (25.8 percent vs 19.0 percent), rib (40.0 percent vs. 32.2 percent), and skull (10.1 percent vs 8.7 percent) fractures.

In the as-treated analysis, cumulative bisphosphonate exposure was associated with significantly reduced fractures (sHR, 0.95, 95 percent confidence interval, 0.91–0.98). Bisphosphonate users spent 29.9 percent person-years of follow-up on the drug.

The findings underscore the need for efforts to increase bisphosphonate uptake and drug continuation in the present population.