Analysis of electronic medical records for more than 120,000 people with osteoporosis or fragility fractures found lower dementia rates among users of common osteoporosis drugs such as alendronate and zoledronate.
Patients aged 60+ with osteoporosis or fragility fractures who took nitrogen-containing bisphosphonates (NBPs) had a 16% lower risk of Alzheimer’s disease and related dementias compared with untreated patients.
Researchers estimate that treating 48 patients with NBPs for five years could potentially prevent one case of dementia.
The study used Hong Kong’s citywide electronic medical records spanning 2005–2020 and was published in Alzheimer’s & Dementia (July 21, 2025).
# What the study looked at Researchers at the University of Hong Kong (HKUMed) analyzed citywide electronic medical records for people age 60 and older who had osteoporosis or fragility fractures between 2005 and 2020. They compared dementia outcomes among three groups: patients treated with nitrogen-containing bisphosphonates (NBPs), patients receiving other osteoporosis medications, and untreated patients.
# Main findings NBP users showed a lower incidence of Alzheimer's disease and related dementias. The study reported a 16% lower risk versus untreated patients and a 24% lower risk versus patients on other osteoporosis drugs. The protective association was especially clear among women and people who had suffered hip fractures.
Based on the researchers' calculations, treating 48 patients with NBPs for five years could possibly prevent one case of dementia. The study names common NBPs such as alendronate and zoledronate.
# Why researchers considered this question
# What the study does and does not show This is a population-based, observational analysis of medical records. It shows an association between NBP use and lower dementia risk in a large real-world cohort, but it does not prove cause and effect. The team frames their results as evidence supporting further investigation into whether NBPs might prevent or delay cognitive decline.
# Practical implications for patients and clinicians NBPs such as alendronate and zoledronate are established treatments for strengthening bone and reducing fracture risk. The study suggests a possible additional benefit in reducing dementia risk in older adults with osteoporosis or fragility fractures. The authors propose that existing, widely available medications could offer a pragmatic preventive approach while newer disease-modifying dementia therapies are still limited by cost and availability.
# Study provenance and support The paper, titled "Bisphosphonates and the risk of dementia in patients with osteoporosis or fragility fracture: A population-based study in Hong Kong," was published in Alzheimer's & Dementia on July 21, 2025 (DOI: 10.1002/alz.70503). The work was supported by the Health and Medical Research Fund, Health Bureau, Hong Kong SAR Government (Grant number: 18192451).
# What to watch next Randomized trials or mechanistic studies would be needed to test whether NBPs directly reduce dementia risk. Additional research could clarify which patient groups might benefit most, optimal treatment duration, and whether specific NBPs differ in association strength.
# Bottom line In a large Hong Kong cohort of older adults with osteoporosis or fragility fractures, use of nitrogen-containing bisphosphonates was associated with a lower risk of Alzheimer's disease and related dementias. The evidence supports further clinical and mechanistic studies rather than immediate changes to dementia prevention guidelines.
A Hong Kong study of 121,492 older adults links nitrogen-containing bisphosphonates for osteoporosis to a 16% lower Alzheimer's disease risk.
Researchers in Hong Kong found that widely available bone-strengthening medications were associated with a 16 to 24 percent lower risk of Alzheimer’s and related dementias in older adults.
A nationwide Danish study of more than 132,000 people found a strong association between participants who took a popular cholesterol drug and a decreased risk of dementia.
An experimental compound called AP503 significantly strengthened bones in mice by activating GPR133, a receptor that boosts bone formation while slowing bone loss. Because the same treatment has also been linked to stronger muscles, researchers see intriguing potential for combating age-related decline and osteoporosis
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