BONE MODIFYING AGENTS AND OTHER RISK FACTORS FOR MORTALITY IN THE BRAZILIAN POPULATION WITH OSTEOPOROSIS: A SURVIVAL STUDY

Resumo

Context: Many real-world effectiveness studies have analyzed the effects of bone modifying agents (BMA) on overall survival in various populations with osteoporosis worldwide. However, there are no large-scale studies for the Brazilian population yet. Objective: To investigate the effect of BMA and other associated covariates on the outcome of overall survival in the Brazilian population with osteoporosis treated within the Brazilian Public Health System (BPHS). Methods: Non-concurrent cohort of the Brazilian population treated with BMA in the BPHS from 2000 to 2015. Global survival analysis was conducted, using Kaplan-Meier method and Cox proportional hazards model, with sensitivity analyses addressing additional risk factors. Results: 312,098 patients were included, most being female, aged 56 or older, residing in the southeast or northeast regions of Brazil, and persisting in BMA treatment for less than 12 months. Cox regression analysis identified that calcitriol had a higher risk of death than the anti-resorptive medications (ARM). All other covariates were associated with any cause death risk. Sensitivity analyses corroborated the main findings and showed that black individuals or those with low body weight had a higher risk of death. Conclusion: Monotherapy or polytherapy of ARM, when compared to calcitriol, appear to be protective factors for death risk from any cause in the Brazilian population with osteoporosis. The ARM did significantly differ from each other in the risk of death, whit alendronate and raloxifene showing the lowest risk when compared to other ARM.