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A University of Hong Kong study of medical records from more than 120,000 people aged 60 and older found nitrogen-containing bisphosphonate use was associated with lower dementia risk. The association was 16% compared with no osteoporosis medication and 24% compared with other osteoporosis drugs; the observational study does not show that the drugs prevent dementia.
Researchers at the University of Hong Kong found that older adults taking nitrogen-containing bisphosphonates, a common class of osteoporosis drugs, had a lower recorded risk of dementia than patients in comparison groups. In an analysis of more than 120,000 people aged 60 and older, the association ranged from 16% to 24%, but the observational findings do not establish that the drugs prevent dementia.
The research team analyzed electronic medical records from across Hong Kong for patients with osteoporosis or fragility fractures. The records spanned 2005 through 2020. The study, conducted by researchers in the Department of Pharmacology and Pharmacy at HKUMed, was published in the journal Alzheimer’s & Dementia.
Patients taking nitrogen-containing bisphosphonates, or NBPs, had a 16% lower risk of Alzheimer’s disease and related dementias than patients who received no osteoporosis medication. Compared with patients taking other osteoporosis drugs, NBP users had a 24% lower risk. The report says the association appeared stronger among women and people with a history of hip fracture.
The researchers also estimated that treating 48 patients with NBPs for five years could potentially prevent one dementia case. That estimate comes from the study’s analysis and does not show that treatment would produce that result in a clinical trial. The drugs named in the report include alendronate and zoledronate, which are used to slow bone breakdown and reduce fracture risk.
A Possible Second Benefit for Bone Drugs
The results may matter because NBPs are already used to treat osteoporosis, a condition common among older adults who may also face dementia risk. If further research shows that the association reflects a protective effect, an existing treatment could offer an additional benefit to some people who need it for bone health. The study does not support prescribing these medicines to prevent dementia, however; that would require evidence beyond an association in medical records.
The scale of the issue gives the finding relevance: the report cites more than 55 million people worldwide living with dementia and a projection of 139 million by 2050. Those figures provide background on the need for prevention research, not evidence that NBPs will reduce future cases. The study offers a reason to investigate a potential link, rather than a new prevention recommendation.
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Why Researchers Examined Bone Treatments
Osteoporosis and dementia can affect the same older population and share risk factors, including older age, being female and low physical activity. The HKUMed team had previously reported that osteoporosis and fractures were independent risk factors for dementia, while people with dementia also faced a higher likelihood of falls and broken bones. This overlap prompted the researchers to ask whether medicines for osteoporosis might be associated with cognitive outcomes.
NBPs are among the commonly prescribed treatments for osteoporosis. They slow the breakdown of bone tissue, helping preserve bone strength. The researchers’ interest in possible brain effects stems from evidence that some biological processes affected by these medicines may also be involved in Alzheimer’s disease and related dementias. The present study tested for an association in health records; it did not establish how any potential brain effect would work.
“Our study provides evidence that NBPs may offer dual benefits in strengthening bones and reducing fracture risk, as well as potentially preventing ADRD.”
— Professor Cheung Ching-lung, associate professor in HKUMed’s Department of Pharmacology and Pharmacy
Association Is Not Proof of Prevention
Because the study was observational, it cannot determine whether NBPs themselves caused the lower dementia risk. Differences between people taking NBPs, people receiving other osteoporosis medicines and those receiving no medication could contribute to the observed results. The report does not establish a biological mechanism or show that starting an NBP changes an individual’s dementia risk.
The supplied findings do not give details on the study’s adjustment for other health and demographic differences, the size of each treatment group, or the uncertainty ranges around the risk estimates. They also do not establish whether results apply to people without osteoporosis or fragility fractures. Further research is needed to test whether the association is causal and to clarify which patients, if any, might benefit.
Further Studies Must Test the Link
The researchers say their results support further investigation into whether NBPs can prevent or delay cognitive decline. The next step is not a change in established osteoporosis care based on this study alone: the report does not announce a clinical trial, timetable, or revised treatment guidance. Research that can better separate the drug’s effect from other differences among patients would be needed to assess prevention potential.
For now, the finding is a research lead for people studying both bone health and dementia. Whether a controlled study will be conducted, when new results might be available, and whether the apparent association holds in other populations remain unknown.
Key Questions
Which osteoporosis drugs were associated with lower dementia risk?
The study examined nitrogen-containing bisphosphonates, including alendronate and zoledronate, according to the report.
How much lower was the risk in the study?
NBP use was associated with a 16% lower risk compared with no osteoporosis medication and a 24% lower risk compared with other osteoporosis drugs. These are comparisons from the study, not proof that the drugs caused the difference.
Does the study prove these medicines prevent dementia?
No. It was an observational study based on medical records, so it found an association but could not establish that the medicines caused a reduction in dementia risk.
Should people take bisphosphonates to prevent dementia?
The findings do not establish a basis for taking these drugs for dementia prevention. Treatment decisions for osteoporosis should be discussed with a qualified health professional.
Source: sciencedaily.com
