OBJECTIVES:

Osteoporosis is a major epidemic disease worldwide. Women over 50 years old and patients with dialysis are at high risk for osteoporosis. Hip fracture alone was estimated to shorten 11.2 years of lifespan in women. However, the clinical effectiveness of anti-osteoporosis medications (AOMs), including alendronate and raloxifene, in dialysis patients was unclear. The objective of this study was to investigate the effectiveness of AOMs in preventing secondary hip fractures in women on dialysis.

METHODS:

We used 2004-2012 National Health Insurance Research Datasets in Taiwan to conduct a retrospective cohort study. Women age 50 and older, undergoing long-term dialysis, and with newly diagnosed hip fracture were enrolled. The patients were divided into AOMs users and AOMs non-users and 1:1 matched on age, the duration of dialysis, and comorbidities and co-medications with propensity score. The patients were followed for the occurrence of secondary hip fractures.

RESULTS:

We identified 1,079 dialysis women matched our inclusion criteria in the database. After the matching, there were 74 patients in AOMs users and nonusers, respectively. Use of AOMs exhibited a similar risk of secondary hip fracture ((adjusted hazard ratio(aHR): 0.60; 95% CI: 0.16-2.20) compared with the AOMs non-users. A similar effect of secondary prevention for hip fractures was also observed in the patients use of alendronate and raloxifene (aHR: 2.76; 95% CI: 0.22-35.30).

CONCLUSIONS:

This is the first population-based study to investigate the effectiveness of AOMs in women on dialysis. Our results demonstrated that AOMs did not significantly decrease the risk of secondary hip fractures. Further attentions to fit the unmet medical need in women on dialysis are warranted.