Effectiveness of treatment initiation for secondary fracture prevention in the older population: Japanese Bone-fracture Osteoporosis in Late-stage population Database study (J-BOLD) – emulation of a randomized target trial
Authors' conclusion
Early initiation and sustained use of osteoporosis medication significantly reduced the risk of secondary fractures, particularly hip fractures, in men and women aged ≥ 75 years.
Study context
- Population
- Individuals aged ≥ 75 years with recent osteoporotic fractures, Japanese administrative claims data 2014–2022 (mean age 83.7 years; 77.9% women)propensity-score matched
- Participants
- 53,436 individuals
- Exposure
- Osteoporosis medication initiated within 3 months after fracture vs no initiation
- Exposedn = 26,718
- Controlsn = 26,718reference
- Outcome
- Secondary fractures at any and specific sites
Methodological detailsJapanese Bone-fracture Osteoporosis in Late-stage population Database study, J-BOLD, emulation of a randomized target trial, high-dimensional propensity score matching, Cox regression
- Japanese Bone-fracture Osteoporosis in Late-stage population Database study, J-BOLD
- Emulation of a randomized target trial
- High-dimensional propensity score matching
- Cox regression
Main finding
As reported in the abstract
Any secondary fracture, HR exposed vs controls · After ≥ 6 months of treatment
HR, men
0.71
95% CI 0.60–0.86
HR, women
0.78
95% CI 0.71–0.88
Observational data: associations, not effects.
Further findings
Hip fracture, HR exposed vs controls · After ≥ 6 months of treatment
- HR, men
- 0.56 (95% CI: 0.36-0.80)
- HR, women
- 0.60 (95% CI 0.49-0.72)
Any secondary fracture, HR exposed vs controls · After ≥ 12 months of treatment
- HR, men
- 0.65 (95% CI: 0.48-0.82)
- HR, women
- 0.74 (95% CI: 0.68-0.85)
Hip fracture, HR exposed vs controls · After ≥ 12 months of treatment
- HR, men
- 0.59 (95% CI: 0.19-0.84)
- HR, women
- 0.55 (95% CI: 0.44-0.69)
Original publication
Effectiveness of treatment initiation for secondary fracture prevention in the older population: Japanese Bone-fracture Osteoporosis in Late-stage population Database study (J-BOLD) – emulation of a randomized target trial. Osteoporos Int. Published 4 September 2025. doi:10.
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