HMN 2025: How Men and women may need different medications to avoid broken bones

A new international study published in Osteoporosis International and led by Monash’s Center for Medicine Use and Safety (CMUS) has investigated the risks of a second hip fracture, subsequent fractures, and death in people prescribed two different classes of bone strengthening medications.

The researchers conducted a series of parallel population-based cohort studies in Australia, Hong Kong, Taiwan and the United Kingdom. The studies compared treatment outcomes in people prescribed bisphosphonates and denosumab following their first hip fracture.

Overall, bisphosphonate users had a 25% higher rate of any subsequent fracture than denosumab users. However, men using bisphosphonates rather than denosumab had a lower rate of death.

People with and without dementia appeared to derive similar benefits from each medication. This is important because people with dementia and frailty are often under-treated with bone strengthening medications after experiencing a hip fracture, despite being at high risk of subsequent fractures.

Associate Professor Jenni Ilomaki, from CMUS and the study’s lead author, said, “We set out to investigate the risk of fracture and death in people with dementia and frailty prescribed bisphosphonates or denosumab. We found no significant difference in treatment outcomes in people with or without dementia or frailty. We did, however, identify an unexpected sex-related difference. Our hope is that this study is a building block toward better informed practice moving forward.”

Director of CMUS and senior author of the study, Professor Simon Bell, said the relative effectiveness of first-line osteoporosis medications post-hip fracture in people with dementia or frailty remains poorly researched.

“Our research is important because 1 in 5 people who experience a hip fracture have dementia, yet people with dementia are less likely to receive osteoporosis treatment and have a higher risk of second fractures and post-fracture mortality,” Professor Bell said.

The authors, who specialize in analyzing the safe and effective use of medications, particularly in older populations, believe research into the effectiveness of bone strengthening medications in people with dementia or frailty post fracture warrants further investigation.

“We know from previous studies that fall-related injuries are common in people with dementia and that second hip fracture is two-fold higher in people with dementia than without dementia,” Professor Bell said.

“Despite the high incidence of hip fractures in people with dementia, most osteoporosis clinical guidelines don’t make specific treatment recommendations for people with dementia or frailty—this is a gap that needs to be addressed.”

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