Osteoporosis & bone health

Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture: a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

Osteoporos IntPublished Population-wide cohort study

Authors' conclusion

In population-wide real-world data, women exposed to bisphosphonates and denosumab had a lower hip fracture risk than the unexposed population after adjusting for comorbidity.

Study context

Population
Norwegian women aged 50–89 in 2005–2016 (Norwegian prescription database (NorPD) prescription data; all hospital-treated hip fractures)
Participants
1,044,661 women
Exposure
Bisphosphonate or denosumab use vs unexposed population
  • Bisphosphonaten = 77,755
  • Denosumabn = 4,483
Outcome
First-time hip fracture
Methodological detailsflexible parametric survival analysis, time-varying exposure, adjusted for Rx-Risk Comorbidity Index (time-varying)
  • Flexible parametric survival analysis
  • Time-varying exposure
  • Adjusted for Rx-Risk Comorbidity Index (time-varying)

Main finding

As reported in the abstract

First-time hip fracture, fully adjusted
Fully adjusted
Each group vs unexposed populationHazard ratio (95% CI)
Bisphosphonate
0.95(0.91–0.99)
Denosumab
0.60(0.47–0.76)

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
Hip fracture in denosumab users with previous bisphosphonate useDenosumab after previous bisphosphonatevs Unexposed populationLowest fracture risk0.42 (0.29–0.61)

Hip fracture by treatment duration

Bisphosphonate: significantly reduced risk vs population after 3 years
Denosumab: significantly reduced risk vs population after 6 months

Original publication

Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture: a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Osteoporos Int. Published 27 April 2023. doi:10.1007/s00198-023-06752-4

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