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Treatment with alendronate protects against hip fracture in older patients taking prednisolone

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The osteoporosis medication alendronate offers effective protection against hip fracture during cortisone treatment, according to a Swedish study.

Older patients taking medium to high doses of oral glucocorticoids can experience a side effect of weakening bones. For example, cortisone treatment to counteract inflammation conditions such as rheumatoid or muscular arthritis doubles the risk of hip fracture.

But the study published in the Journal of the American Medical Association (JAMA) found that, if patients also take the bisphosphonate alendronate, it reduces the risk of hip fracture by 65%.

Researchers focused on 1,802 elderly patients who were prescribed alendronate after starting treatment with the cortisone preparation prednisolone in tablet form. They had been taking the drug for at least three months, at a dosage of at least five milligrams per day.

These patients were compared against matched controls — another 1,802 patients — who took prednisolone tablets but did not receive the protective alendronate treatment.

Of those who took cortisone tablets, but did not receive protective treatment, 4.1% had broken their hip after around 15 months. In the group that also received alendronate, the equivalent figure was 1.5%. This represented a significant reduction (65%) in the risk.

“If a patient receives the protective treatment, the risk of suffering a new fracture, and in particular the new hip fractures that we are really keen to prevent, reduces dramatically,” said Kristian Axelsson, co-author and doctoral candidate, who also works as a resident physician in the orthopaedics department at Skaraborgs Hospital.

“The number of patients receiving the treatment is quite low at present, but we are hoping this study will mean more prednisolone patients will receive the fracture-preventing treatment,” he added.

There was no increased risk of side effects linked to the alendronate treatment.

“Although the findings are limited by the observational study design and the small number of events, these results support the use of alendronate in this patient group,” the study concluded.