Bisphosphonate Use and Reduced All-Cause Mortality in Korean Women Older than 50 Years: A Nationwide Sample Cohort Study

Background: The survival impact of bisphosphonates (BPs) remains uncertain, particularly in East Asian populations, where new-user analyses have been limited.Methods: This was a retrospective, new-user cohort study using the Korean National Health Insurance Service–National Sample Cohort (2002–2011). We identified new users of BPs (N=41,854), and a 1:1 age-matched control group (N=41,854) among women aged ≥ 50 years. Participants were followed for all-cause mortality for up to 10 years. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs), adjusting for age and the Charlson Comorbidity Index.Results: A total of 83,708 women were included. Compared with the control group, the risk of all-cause mortality was lower in BP group. BP users showed adjusted HR of 0.47 (95% confidence interval, 0.44–0.49; P<0.001) compared to controls. Conclusions: In this large, nationwide Korean cohort, initiating BPs was associated with a reduced risk of all-cause mortality in women aged 50 and older. These findings suggest that BPs may have survival benefits beyond fracture prevention.