Estimating effectiveness of bone-specific treatment, calcium and vitamin D supplementation on fracture rates and mortality: a cohort study
Description: In Sweden, 70,000 individuals are affected each year by a fragility fracture, those that often occur after low-energy trauma. With a lifetime risk of 50% for women and 25% for men, Sweden has one of the highest incidences in the world of these fractures. These cause great suffering, increase the risk of early death and impose high costs for society. Over the last few decades bone-saving drugs have been developed. Controlled clinical trials have shown these to reduce the risk of fracturesbut only among relatively healthy high risk women younger than age 80. Since these studies did not include either women over age 80 or any men, and only studied treatments that lasted a few years, understanding of the use of these agents remains incomplete. Calcium and vitamin D supplements have also been recommended for fracture prevention, but in randomized trials, their effect on fracture risk has been inconsistent; a clear benefit has only been found in the institutionalized elderly. Bone-specific drugs, as well as calcium and vitamin D supplements also have side effects. Treatment with bisphosphonates has been associated with osteonecrosis of the jaw, atypical femoral fractures, atrial fibrillation and esophageal inflammatory changes such as erosive esophagitis and esophageal cancer. Meta-analyses of randomized studies have suggested an increased risk of myocardial infarction with calcium supplement use. Therefore, needed is a population-based study with an unselected patient material to compare treatment benefits with side effects. What is the effectiveness of preventing fractures at population level and how does treatment affect mortality? Men and women, 50 years of age or older, constitute the study base and a cohort of 327,900 has been created. Information has been extracted from medical records and national registers and, after compilation, the occurrence of different fracture types and mortality is to be calculated depending on the type of drug use.
Amount: SEK 3,500,000
Funding type: grant
Funder scheme: Unclassified
Start date: 2020-01-01
End date: 2022-12-31
Investigator: Karl Michaëlsson
Institution: Uppsala University
Funded outputs count: 0
Funder award ID: 2019-00541
OpenAlex ID: G760383729