Jenni IIomaki

People living with dementia are at an increased risk osteoporosis and hip fracture compared to people without dementia. However, recent reports suggest people with dementia are less likely to be prescribed evidence-based treatments for osteoporosis to prevent recurrent fractures. The aim of this project was to compare the effectiveness of bisphosphonates and denosumab (preferred therapies following hip-fracture to prevent new fractures) against the risk of future hip-fractures, any fractures and death among people aged 50+ years who have been hospitalised with a new hip fracture.

Our study included people with dementia, people who are frail, men and women, separately We obtained results for these analyses from four jurisdictions; Australia, Hong Kong, the UK and Taiwan. People living with dementia were similarly prescribed bisphosphonates in relation to denosumab as were the primary cohort of all people aged 50 and over in Australia, Taiwan and the UK.

We found that bisphosphonate and denosumab users had similar risks of recurrent hip fractures. This was true for the general population of people aged 50 and over, people with dementia, frail people, men and women. Another key finding was that bisphosphonate users had a 24% higher risk of any future fractures, compared to denosumab users in the general population; in men the risk was 27% higher for bisphosphonate versus denosumab users. Overall, bisphosphonates were not associated with an increase in any-fracture risk among people with dementia or frailty, compared to denosumab. In Australia, people with dementia on bisphosphonates were at an 89% increased risk of this any fractures, compared to people with dementia using denosumab.

Bisphosphonates and denosumab were associated with similar risks of death in the general population, people with dementia, people with frailty and women. Men using bisphosphonates had a 13% lower risk of all-cause mortality than men using denosumab.
Our results suggest clinical guideline recommendations for general older populations with respect to preferred medications post hip fracture apply similarly to people with dementia and frailty and to both men and women.

Sing C-W, Lin T-C, Bartholomew S, et al. Global epidemiology of hip fractures: a study protocol using a common analytical platform among multiple countries. BMJ Open. 2021 Jul 28;11(7):e047258 doi: 10.1136%2Fbmjopen-2020-047258

At the time of award, Dr Ilomaki worked at the Centre for Medicine Use and Safety at Monash University.