Hip Fracture Risk and Safety With Alendronate Treatment in the Oldest-Old

J Intern Med. 2017 Dec;282(6):546-559. doi: 10.1111/joim.12678. Epub 2017 Oct 4.


Background: There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (≥80 years old), the population with the highest fracture risk, has not been studied.

Objective: To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety.

Methods: Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term.

Results: The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI.

Conclusion: In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

Keywords: alendronate; efficiency; elderly; fracture; osteoporosis; treatment.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Alendronate / therapeutic use*
  • Body Mass Index
  • Bone Density Conservation Agents / therapeutic use*
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Hip Fractures / prevention & control
  • Humans
  • Male
  • Osteoporotic Fractures / prevention & control*
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Sweden
  • Treatment Outcome


  • Bone Density Conservation Agents
  • Alendronate