Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and anti-osteoporotic drugs are associated with lower mortality. A nationwide study in Finland†
Ilona Nurmi-Lüthje1,2,* ilona.nurmi at pp.inet.fi
1 Center for Injury and Violence Prevention, Health Center of Kouvola, FI-45100 Kouvola, Finland
2 Hjelt Institute, Department of Public Health, FI-00014 Helsinki University, Finland
3 National Institute for Health and Welfare, FI-00271 Helsinki, Finland
4 North Kymi Hospital, FI-45750 Kuusankoski, Finland
Vol. 26 Issue 7, Journal of Bone and Mineral Research
We previously found a positive association between calcium plus vitamin D and anti-osteoporotic 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 (n?=?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 by using the Kaplan-Meier estimator. The relationship between mortality and medication purchases was modeled using Cox's proportional hazards regression with time-dependent covariates for medication use.
One in four women and one in ten men with a hip fracture were treated for osteoporosis in Finland.
Unadjusted one-year mortality was lower among patients who purchased calcium plus vitamin D or vitamin D supplements and anti-osteoporotic drugs than among those who did not purchase these medications (HR 0.74; 95% CI 0.67-0.81).
The difference in unadjusted cumulative mortality remained in favor of the drug users for at least five years.
Among men the use of calcium plus vitamin D or vitamin D supplements was associated with lower one-year mortality even after adjustments for observed confounders (HR 0.74; 95% CI 0.56-0.97).
Among women the use of anti-osteoporotic drugs was associated with lower mortality (HR 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 anti-osteoporotic drugs were used simultaneously, HR being
- 0.72 (95% CI 0.50-1.03) in men and
- 0.62 (95% CI 0.50-0.76) in women.
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