Drug adherence and treatment duration for denosumab and mortality risk among hip fracture patients

Tsai, Yi-Lun; Wu, Chih‐Hsing; Li, Chia-Chun; Shih, Chien-An; Chang, Yin-Fan; Hwang, Jawl‐Shan; Tai, Ta-Wei

doi:10.1007/s00198-023-06845-0

Cited by 5 publications

(6 citation statements)

References 48 publications

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“…It is known that better adherence to anti-osteoporosis treatment may yield better outcomes and survival [ 67 ]. The education and support provided by FLS case managers regarding osteoporosis, fracture prevention strategies, and medication adherence could also contribute to a reduction in subsequent fractures and improved patient outcomes.…”

Section: Resultsmentioning

confidence: 99%

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Tai,

Chen,

Shih

et al. 2024

Osteoporosis and Sarcopenia

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Section: Resultsmentioning

confidence: 99%

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Tai,

Chen,

Shih

et al. 2024

Osteoporosis and Sarcopenia

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“…[50] Interestingly, Tsai and colleagues demonstrated in their recently published study that patients with an osteoporotic hip fracture who took their Dmab injection on time and were treated for a long duration had a decrease in mortality risk due to cancer by 30%, cardiovascular events by 35%, and stroke by 16%. [44] In the head-to-head comparison of Dmab with BPs in people treated without a prior fracture, the results surprisingly demonstrated a higher mortality risk in Dmab users compared with oral BP but not Zol users. These differences may be partly explained by Zol being a better comparator to Dmab than oral BPs, as they are both given parenterally with infrequent dosing.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

“…A more recent study by Tsai et al, examined the association between drug adherence, treatment duration and mortality risk of patients receiving Dmab after osteoporotic hip fracture surgery; the authors found that patients with better Dmab drug adherence and longer treatment duration had lower risk of all‐cause mortality and lower mortality rates due to cancer and cardiovascular diseases. [ 44 ]…”

Section: Discussionmentioning

confidence: 99%

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Denosumab and Mortality in a Real-World Setting: A Comparative Study

Alarkawi,

Tran,

Chen

et al. 2023

Journal of Bone and Mineral Research

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Denosumab (Dmab) is increasingly prescribed worldwide. Unlike bisphosphonates (BPs), its effect on mortality has yet to be well‐explored. This study examined the association between Dmab and all‐cause mortality compared to no treatment in subjects with a fracture and BPs in subjects without a fracture. The study population was from The Sax Institute's 45 and Up Study (n= 267,357), a prospective population‐based cohort with questionnaire data linked to hospital admissions1, medication records2 and stored securely3.The new‐user cohort design with propensity‐score (PS) matching was implemented.In the Fracture cohort, Dmab and oral BP users were matched 1:2 to no treatment (Dmab: 617 women, 154 men, and oral BPs: 615 women, 266 men).In the No‐fracture cohort, Dmab users were matched 1:1 with oral BPs and zoledronic acid (Zol) users (Dmab:oral BPs – 479 men, 1534 women and Dmab:Zol – 280 men, 625 women).Mortality risk was measured using gender‐specific pairwise multivariable Cox models.In the Fracture cohort, compared with no treatment, Dmab was associated with 48% lower mortality in women (HR 0.52; 95% CI, 0.36‐0.72) but not in men. Oral BPs were associated with 44% lower mortality in both sexes (women HR 0.56; 95% CI, 0.42‐0.77 and men HR 0.56; 95% CI, 0.40‐0.78).In the No‐fracture cohort, compared with BPs, Dmab was associated with 1.5 to 2.5‐fold higher mortality than oral BPs (women HR 1.49; 95% CI, 1.13‐1.98 and men HR 2.74; 95% CI, 1.82‐4.11) but similar mortality to Zol.Dmab in women and oral BPs were associated with lower post‐fracture mortality than no treatment. However, Dmab users had generally higher mortality than oral BP users in those without fractures.This article is protected by copyright. All rights reserved.

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“…According to a recent review, the mean persistence of oral bisphosphonates for 1 year ranges from 17.7% to 74.8%, and decreases to 12.9-72.0% at 2 years [65]. Similarly, in a large cohort of osteoporotic patients, good adherence to therapy with denosumab (i.e., an average interval of denosumab injection within 7 months) was reported in only 56.9% of patients [66]. Regarding the causes of discontinuation, a recent study revealed that more than a half of patients who interrupt the treatment decide to withdraw from drugs on their own initiative, and among them, the main motivation (46.3% of cases) is forgetting about the visit at the outpatient clinics, whereas only 15.2% of patients discontinue drugs due to medication-related factors [67].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Polyphenols on Bone Metabolism in Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Control Trials

Salvio,

Ciarloni,

Gianfelice

et al. 2023

Antioxidants

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Osteoporosis is a condition favored by the postmenopausal decline in estrogen levels and worsened by oxidative stress (OS). Polyphenols are natural compounds abundantly found in fruits and vegetables, and they exert antioxidant and hormonal effects that could be useful in osteoporosis prevention, as suggested by epidemiological studies showing a lower incidence of fractures in individuals consuming polyphenol-rich diets. The aim of our meta-analysis is to evaluate the effects of polyphenols on bone mineral density (BMD, primary endpoint) and bone turnover markers (BTMs, secondary endpoint) in postmenopausal women. Twenty-one randomized control trials (RCTs) were included in our analysis after in-depth search on PubMed, EMBASE, and Scopus databases. We found that supplementation with polyphenols for 3–36 months exerted no statically significant effects on BMD measured at lumbar spine (sMD: 0.21, 95% CI [−0.08 to 0.51], p = 0.16), femoral neck (sMD: 0.16, 95% CI [−0.23 to 0.55], p = 0.42), total hip (sMD: 0.05, 95% CI [−0.14 to 0.24], p = 0.61), and whole body (sMD: −0.12, 95% CI [−0.42 to 0.17], p = 0.41). Subgroup analysis based on treatment duration showed no statistical significance, but a significant effect on lumbar BMD emerged when studies with duration of 24 months or greater were analyzed separately. On the other hand, we found a significantly slight increase in bone-specific alkaline phosphatase (BALP) levels (sMD: 1.27, 95% CI [1.13 to 1.42], p < 0.0001) and a decrease in pyridinoline (PD) levels (sMD: −0.58, 95% CI [−0.77 to −0.39], p < 0.0001). High heterogeneity among studies and unclear risk of bias in one third of the included studies emerged. A subgroup analysis showed similar effects for different duration of treatment and models of dual-energy X-ray absorptiometry (DXA) scanner. More robust evidence is needed before recommending the prescription of polyphenols in clinical practice.

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Drug adherence and treatment duration for denosumab and mortality risk among hip fracture patients

Cited by 5 publications

References 48 publications

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Denosumab and Mortality in a Real-World Setting: A Comparative Study

The Effects of Polyphenols on Bone Metabolism in Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Control Trials

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