Post–hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs is associated with lower mortality: A nationwide study in Finland

Abstract

We previously found a positive association between calcium plus vitamin D and antiosteoporotic drugs and survival among hip fracture patients. Our aim was to verify this observation using a nationwide database. A retrospective cohort of home-discharged hip fracture patients aged 50 years or older (n ¼ 23,615) was enrolled from the national database. Primary exposure was medical treatment for osteoporosis, and the outcome was all-cause mortality. Cumulative mortalities were calculated using the Kaplan-Meier estimator. The relationship between mortality and medication purchases was modeled using Cox's proportional hazards regression with timedependent covariates for medication use. One in 4 women and 1 in 10 men with a hip fracture were treated for osteoporosis in Finland. Unadjusted 1-year mortality was lower among patients who purchased calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs than among those who did not purchase these medications [hazard ratio (HR) ¼ 0.74, 95% confidence interval (CI) 0.67-0.81]. The difference in unadjusted cumulative mortality remained in favor of the drug users for at least 5 years. Among men, the use of calcium plus vitamin D or vitamin D supplements was associated with lower 1-year mortality even after adjustments for observed confounders (HR ¼ 0.74, 95% CI 0.56-0.97). Among women, the use of antiosteoporotic drugs was associated with lower mortality (HR ¼ 0.79, 95% CI 0.67-0.93). There was a tendency to even better survival in both genders if calcium plus vitamin D or vitamin D supplements and antiosteoporotic drugs were used simultaneously, the HR being 0.72 (95% CI 0.50-1.03) in men and 0.62 (95% CI 0.50-0.76) in women. ß

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…Risk factors for mortality after a hip fracture are higher age, male gender, comorbidity, cancer, functional inability and treatment with opiates, delayed surgery, major postoperative complications and use of assistive devices (Agusti et al 2012, Alegre-Lopez et al 2005, Maggi et al 2010, Paksima et al 2008. Bone medication (Agusti et al 2012, Nurmi-Luthje et al 2011 as well as calcium and vitamin D supplements (Nurmi-Luthje et al 2011) are associated with deceased mortality risk.…”

Positive Effects of a Sufficient Pre-fracture Serum Vitamin D Level on the Long-Term Survival of Hip Fracture Patients in Finland: A Minimum 11-Year Follow-Up

“…In a recent prospective study, predictors of long-term mortality in females with hip fracture were older age ([80 years) and dementia, and in males, correspondingly, were osteoporosis and older age ([80 years) [19]. During the last 10 years, some studies have shown an association between anti-osteoporotic treatment and reduced all-cause mortality [20,21].…”

Prescription of anti-osteoporosis medications after hospitalization for hip fracture: a multicentre Italian survey

“…Therefore, current national and international guidelines recommend the use of pharmacological treatments after hip fracture [10,11]. Moreover, the results of several studies showed a decreased mortality rate in patients who were managed with antiosteoporotic drugs as compared with those who were not [12][13][14]. In particular, in the HORIZON study [13] hip fracture patients were randomly assigned to receive annually zoledronic acid either by intravenous infusion or a placebo infusion; both groups received both oral calcium and vitamin D daily.…”