Osteoporosis drug may be cardioprotective

12 May 2018

Professor Annie Kung shows that an anti-osteoporosis drug, alendronate, was associated with reduced risk of cardiovascular events in patients with hip fracture.

Hip fracture is a significant health problem for older people and is often associated with other diseases. According to the Hong Kong Hospital Authority, one-third of patients died in the first year following a hip fracture, with cardiovascular events such as myocardial infarction and stroke as major causes of death.

Professor Annie Kung, Croucher Scholarship 1986

Professor Annie Kung (Croucher Scholarship 1986) and a research team at The University of Hong Kong, in collaboration with Harvard Medical School, are the first to show that an anti-osteoporosis drug, alendronate, was associated with reduced risk of cardiovascular events in patients with hip fracture, compared to non-treatment.

Alendronate is one of several bisphosphonate drugs used as a first-line treatment of osteoporosis to prevent a second fracture in patients.

In previous clinical trials of the drug, it was found to be useful in treating calcification of blood vessels and even reducing death rate from cardiovascular events. However, there is limited data on the link between the bisphosphonates drug and the risk of cardiovascular events. A recent meta-analysis of randomised controlled trials reported a lower risk of cardiovascular death in the use of bisphosphonates but the result was not statistically significant. .

The research team conducted a population-based study using an anonymised territory-wide healthcare database of the Hong Kong Hospital Authority. The aim was to investigate the risk of cardiovascular events with and without the use of alendronate in patients with hip fracture.

The study included over 30,000 patients with newly diagnosed hip fracture from 2005 through 2013. The team examined the treatment in these patients and matched the alendronate-treated and non-treated patients by propensity scores, a statistical matching technique, to ensure their similarity. The matched patients were followed until November 6, 2016, and their risks of cardiovascular events were compared.

There were 3,081 alendronate-treated patients and 9,098 non-treated patients in the final analysis. In the first year of follow-up, the team found that 10 treated-patient (0.32%) and 88 non-treated patients (0.97%) died of cardiovascular events. The risk of cardiovascular death and heart attacks in treated patients were reduced by 67% and 45%, respectively, compared to non-treated patients. The association was seen for up to ten years after fracture.

The study highlights the importance of alendronate treatment after hip fracture, encouraging its use in clinical practice.

The findings are published in the latest issue of the Journal of Bone and Mineral Research.

Dr Ching-lung Cheung of the University of Hong Kong added, “The research further encourage the use of bisphosphonates in patients with hip fracture, and the beneficial effect is not only limited to bone, but also for the heart.”

Professor Annie Kung received the Croucher Scholarship in 1986. Kung is now Honorary Clinical Professor of The University of Hong Kong and Honorary Consultant to Queen Mary Hospital. She is a specialist in Internal Medicine, with special interest in Endocrinology, Diabetes and Metabolism. Kung graduated from the University of Hong Kong with distinctions. She was formerly a Chair Professor at the Department of Medicine and Chairman of the Clinical Trial Centre of LKS Faculty of Medicine of The University of Hong Kong. She had an honorary appointment as Honorary Professor of Sun Yat-sen University of Medical Sciences, Guangzhou, China. She was also the Director of the Osteoporosis Centre at Queen Mary Hospital.

To view Professor Kung’s Croucher profile, please click here.