Effectiveness of Bisphosphonates in Young Adults With Fragility Fractures: Representative Population-based Cohort Study

Abstract

Context Fragility fractures in young adults present significant clinical challenges due to the limited evidence on the effectiveness of bisphosphonates in preventing subsequent fractures. Objective To evaluate the effectiveness of bisphosphonate therapy in reducing the fracture risk among premenopausal women with a history of osteoporotic fractures. Design A population-based retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort in South Korea, covering the years 2003 to 2014. Setting A nationwide healthcare setting utilizing a representative cohort database. Participants Among 2087 premenopausal women with osteoporotic fractures, participants were propensity score-matched based on age and body mass index at a 1:3 ratio, resulting in 132 bisphosphonate users and 396 nonusers. Intervention Bisphosphonate treatment. Main Outcome Measures The incidence of osteoporotic fractures. Results Bisphosphonate users had a significantly lower risk of major osteoporotic fractures [hazard ratio (HR) 0.618, 95% confidence interval (CI) 0.396-0.963] compared to nonusers. Ibandronate users showed significant reductions in both major osteoporotic (HR 0.376, 95% CI 0.164-0.861) and nonvertebral fractures (HR 0.214, 95% CI 0.052-0.877). Also, longer duration of bisphosphonate use (≥180 days) was associated with a significantly lower risk of major osteoporotic and nonvertebral fractures (HR 0.528, 95% CI 0.300-0.929; HR 0.409, 95% CI 0.187-0.895, respectively). Conclusion Bisphosphonate therapy significantly reduces fracture risk in premenopausal women with previous osteoporotic fractures, especially at higher cumulative doses. These findings support considering bisphosphonates as a treatment option in premenopausal women at high risk of fractures. © 2025 Elsevier B.V., All rights reserved.