Antiresorptive injections in older adult patients with prior osteoporotic fractures: a real-world observational study

Summary : Injectable antiresorptive drugs may reduce refracture risk in older adults with previous fractures, though further research is needed to explore related factors, including the crucial role of consistent adherence. Purpose: Osteoporosis increases fracture risk, particularly in older adults. Spinal and hip fractures are common and costly complications. To examine the effectiveness of parenteral antiresorptive medications—denosumab and zoledronate—in reducing refracture rates among older adults with prior spinal or hip fractures. Methods: A nationwide retrospective cohort study was conducted using data from Taiwan’s National Health Insurance Research Database (2011–2020). Patients aged 50 and older with spinal or hip fractures were divided into a treatment group (received zoledronate or denosumab) and a control group (no osteoporosis treatment). A 1:1 matching based on age, sex, and Charlson Comorbidity Index was performed. Kaplan–Meier method and Cox proportional hazards regression were used for analysis. Results: Out of 23,331 eligible patients, 582 were in the treatment group and 17,281 in the control group. After matching, 211 patients received zoledronate and 367 received denosumab. The treatment group showed a trend toward lower refracture risk compared to the control group, though not statistically significant. Hazard ratios were 0.63 for zoledronate and 0.80 for denosumab, indicating potential benefits. There was no substantial difference between the two medications. Conclusion: This is the first real-world study to assess the effectiveness of complete adherence to parenteral antiresorptive medications in reducing the risk of refractures among older adults with prior spinal or hip fractures. However, further research is needed to confirm these findings and investigate long-term effects.