Clinical impact of bisphosphonate treatment in reducing fragility fractures in Jordan: Insights from a developing country.

UNLABELLED: This study examined whether bisphosphonate treatment can reduce fragility fractures in patients with osteoporosis in Jordan. We found significantly fewer fractures and better quality of life in treated patients, supporting the importance of early treatment in routine care settings.

INTRODUCTION

Osteoporosis is a major public health concern in aging populations, with fragility fractures contributing to significant morbidity, mortality, and healthcare burden. While bisphosphonates are widely used to reduce fracture risk, data from real-life clinical settings in the Middle East remain limited. This study aimed to evaluate the clinical outcomes associated with bisphosphonate therapy among osteoporotic patients in Jordan.

METHODS

We conducted a retrospective, matched case-control study of 1,202 patients aged ≥ 50 years with confirmed osteoporosis across multiple hospitals in Jordan. Patients were grouped based on bisphosphonate treatment status. Clinical and functional outcomes-including fragility fractures, bone mineral density (BMD), FRAIL score, EQ-5D, and self-rated bone health-were compared between groups.

RESULTS

Of 1,202 patients included, 604 received bisphosphonates and 598 did not. The bisphosphonate group had a significantly lower prevalence of fragility fractures (13.1% vs. 36.8%, p < 0.001) and multiple fractures (4.1% vs. 15.1%, p < 0.001). Mean lumbar spine and proximal femur BMD values were higher among treated patients (0.815 ± 0.090 g/cm2 and 0.715 ± 0.080 g/cm2, respectively) compared with non-treated patients (0.760 ± 0.10 g/cm2 and 0.675 ± 0.093 g/cm2, p < 0.05). Corresponding mean T-scores were - 2.3 ± 0.4 vs. - 2.6 ± 0.5 (p = 0.04). Treated patients also had lower mean FRAIL scores (1.3 ± 1.1 vs. 2.1 ± 1.3, p < 0.001) and higher EQ-5D quality of life scores (0.73 ± 0.2 vs. 0.59 ± 0.2, p < 0.001). Self-rated bone health was more favorable in the treatment group (good/very good in 49.3% vs. 21.1%, p < 0.001). These findings were consistent across both clinical and patient-reported outcomes.

CONCLUSION

Bisphosphonate therapy in routine clinical practice was associated with reduced fracture burden and better functional and quality of life outcomes among osteoporotic patients in Jordan. These results highlight the need for improved screening, timely treatment, and comprehensive osteoporosis care strategies in the region.