Effectiveness of treatment initiation for secondary fracture prevention in the older population: Japanese Bone-fracture Osteoporosis in Late-stage population Database study (J-BOLD) - emulation of a randomized target trial
Abstract
Initiating osteoporosis medication within 3 months after fracture reduces secondary fractures, particularly hip fractures, in individuals aged ≥ 75 years. This finding highlights the importance of early and sustained treatment in older populations.
Purpose: To evaluate the efficacy of initiating osteoporosis medication within 3 months after a fracture and continuing it for at least 6 months in preventing secondary fractures among individuals aged ≥ 75 years.
Methods: This study used a targeted trial design, emulating a randomized controlled trial with Japanese administrative claims data from 2014-2022. Among 203,534 individuals with recent osteoporotic fractures, 40,063 initiated osteoporosis medication within 3 months (exposed), while 163,471 did not (controls). High-dimensional propensity score matching identified 53,436 individuals (26,718 exposed and 26,718 controls) for analysis. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for secondary fractures at any and specific sites.
Results: The study population had a mean age of 83.7 years and included 77.9% women. After ≥ 6 months of treatment, HRs for any fracture were 0.71 (95% CI: 0.60-0.86) in men and 0.78 (95% CI: 0.71-0.88) in women. For hip fractures, HRs were 0.56 (95% CI: 0.36-0.80) in men and 0.60 (95% CI 0.49-0.72) in women. After ≥ 12 months of treatment, HRs for any fracture were 0.65 (95% CI: 0.48-0.82) in men and 0.74 (95% CI: 0.68-0.85) in women. For hip fractures,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 203,534 participants or records.
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