Association between denosumab use and risk of osteoarthritis among adults with osteoporosis in a real-world cohort
Main finding · Knee OAResult — go to the resultHazard ratio 0.87 95% CI 0.84–0.91Authors' conclusion
Denosumab use was associated with a reduced risk of incident knee OA compared with bisphosphonates in adults with osteoporosis, with the association being more pronounced among older adults, females, and individuals of Asian ethnicity.
Study context
- Population
- Adults diagnosed with osteoporosis between January 1, 2014 and December 31, 2023, TriNetX Network (mean age 70 years; 87% female)Propensity-score matching (PSM) cohort
- Participants
- 59,157 vs 59,157
- Exposure
- Denosumab vs bisphosphonates
- Denosumabn = 59,157
- Bisphosphonaten = 59,157reference
- Outcome
- Incident knee and hip osteoarthritis (OA)
Methodological detailsnew-user, active-comparator, propensity-score matched, Cox proportional hazards models, TriNetX electronic health records
- New-user
- Active-comparator
- Propensity-score matched
- Cox proportional hazards models
- TriNetX electronic health records
Main finding
Knee OA · 10 years
Hazard ratio
0.87
95% CI 0.84–0.91
Events by group
Denosumabvs Bisphosphonate
HR 0.87 (95% CI 0.84–0.91)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Denosumab | Bisphosphonate | HR (95% CI) | |
|---|---|---|---|---|
| Hip OA · 10 years | 14.5% | 14.4% | 0.98 (0.94–1.03) | |
| Any OA | 0.96 (0.94–0.98) | |||
| Thumb carpometacarpal OA | 0.94 (0.87–1.01) | |||
| Knee OA, older participants (≥ 65 years) (subgroup) | 0.88 (0.84–0.91) | |||
| Knee OA, females (subgroup) | 0.87 (0.83–0.91) | |||
| Knee OA, Asian ethnicity (subgroup) | 0.73 (0.63–0.84) | |||
| 0.512Hazard ratio (log scale) |
Original publication
Association between denosumab use and risk of osteoarthritis among adults with osteoporosis in a real-world cohort. Osteoarthritis Cartilage. Published 9 January 2026. doi:10.
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