The effectiveness of bisphosphonates vs denosumab in people with dementia or frailty post hip fracture: a multi-database cohort study
Main finding · Any subsequent fractureResult — go to the resultSubdistribution hazard ratio 1.16 95% CI 1.11–1.21Authors' conclusion
Bisphosphonate users had higher rates of subsequent fracture than denosumab users. Mortality rates in men were lower with bisphosphonates than denosumab. There were no significant differences by dementia and frailty status.
Study context
- Population
- People aged ≥ 50 after first hip fracture, incl. people with dementia or frailty; Australia, Hong Kong, Taiwan, UK
- Participants
- 18,292 vs 8,560
- Exposure
- Bisphosphonates vs denosumab after first hip fracture
- Bisphosphonatesn = 18,292
- Denosumabn = 8,560reference
- Outcome
- Any subsequent fracture
Methodological detailsparallel cohort studies in Australia, Hong Kong, Taiwan and UK, inverse probability of treatment weighted Cox and competing risk models, meta-analysis across jurisdictions
- Parallel cohort studies in Australia, Hong Kong, Taiwan and UK
- Inverse probability of treatment weighted Cox and competing risk models
- Meta-analysis across jurisdictions
Main finding
As reported in the abstract
Subdistribution hazard ratio
1.16
95% CI 1.11–1.21
Bisphosphonatesvs Denosumab
sHR 1.16 (95% CI 1.11–1.21)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Second hip fracture | sHR 1.13 (95% CI 0.76–1.69) | |
| Mortality | HR 0.99 (95% CI 0.94–1.04) | |
| Any subsequent fracture in men (subgroup) | sHR 1.27 (95% CI 1.15–1.42) | |
| Any subsequent fracture in women (subgroup) | sHR 1.23 (95% CI 1.00–1.52) | |
| Mortality in men (subgroup) | HR 0.90 (95% CI 0.81–0.99) | |
| 0.512Ratio (log scale) |
Any subsequent fracture in people with dementia or frailty (subgroups)
- No higher rate with bisphosphonates in people with dementia or frailty; no differences by dementia or frailty status
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
The effectiveness of bisphosphonates vs denosumab in people with dementia or frailty post hip fracture: a multi-database cohort study. Osteoporos Int. Published 7 December 2025. doi:10.
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