Treatment with active vitamin D metabolites and concurrent treatments in the prevention of hip fractures: A retrospective study

The purpose of this study was to determine the effect of treatment with act ive vitamin D metabolites and other concurrent medication on the prevention of hip fractures in elderly women. We inspected the medical records of the entire female population over 65 years of age on Sado Island, and followed a total of 11377 women for a 3-year period. Of these, 1208 osteoporotic pa tients were treated with either 1,25-(OH)(2)D-3 or 1 alpha-(OH)D-3. The 765 patients who received the minimum effective dosage for more than 6 months made up the 'treatment group'. Nearly half these patients were also treated with either calcitonin or calcium. The 443 patients who received treatment with active vitamin D metabolites, but at a dosage or for a duration that did not meet the criteria for the treatment group, were deemed the 'ineffec tive group'. The remaining 10169 women were the 'non-treatment group'. Frac tures in the nontreatment group occurred at a rate of 39.8 fractures/10000 person-years. The rate in the treatment group was 10.8, which was significa ntly lower (p = 0.039). Interestingly, the fracture rate after ceasing trea tment was 52.1, which was significantly higher (p = 0.002) than the rate in patients receiving treatment. No statistical differences in the fracture r ate were found between the ineffective, non-treatment and post-treatment gr oups. A reduction in the fracture rate was observed only in the treatment s ubgroup that did not also receive calcitonin (p = 0.042), and not in the su bgroup that also received calcitonin therapy (p = 0.333). However, there wa s no statistical difference in the hip fracture rates between these two sub groups (p = 0.157) and the actual number of fractures was minimal (0 vs 2). Therefore, in this study, the advantage of treatment with active vitamin D alone over combined treatment with calcitonin seems to be marginal. In con clusion: (1) treatment with active vitamin D metabolites and with combined therapy may be marginally effective in preventing hip fractures, and (2) st opping the treatment clearly increases the risk of hip fractures.