Evidence map›Paper›PMID 33411003›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2021

Comparative effectiveness of denosumab, teriparatide, and zoledronic acid among frail older adults: a retrospective cohort study.

A R Zullo, Y Lee, C Lary, L A Daiello, D P Kiel, S D Berry

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
3.0field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Review
  5. Observational
  6. Review
  7. Review
  8. Article
  9. Article
  10. Article
  11. Comparison of anti-fracture effectiveness of zoledronate, ibandronate and alendronate versus denosumab in a registry-based cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023
    Article
  12. Article
  13. Article
  14. Article
  15. Controversies in Osteoporosis Treatment of Nursing Home Residents.Journal of the American Medical Directors Association · 2022
    Review
  16. Total Hip Bone Mineral Density as an Indicator of Fracture Risk in Bisphosphonate-Treated Patients in a Real-World Setting.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022
    Observational
  17. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

A R ZulloDepartment of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA. andrew_zullo@brown.edu.ORCID http://orcid.org/0000-0003-1673-4570
Y LeeDepartment of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
C LaryCenter for Outcomes Research, Maine Medical Center, Portland, ME, USA.
L A DaielloDepartment of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
D P KielDepartment of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
S D BerryDepartment of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Brown University · USBeth Israel Deaconess Medical Center · USMaine Medical Center · US

Funding

Understanding Factors Influencing COVID-19 Testing and Vaccination in Immigrant Low-income and Homeless Populations and Testing Targeted InterventionsU54GM115516 · NIGMS · MAINEHEALTH · PI CLIFFORD JAMES ROSEN · 2017 to 2026
$51.6M
Tracking and Evaluation CoreU54GM115677 · NIGMS · BROWN UNIVERSITY · PI ROUNDS, SHARON IRENE SMITH · 2016 to 2025
$45.0M
The role of night shift work in metabolic disorders during and after pregnancyP20GM121301 · NIGMS · MAINEHEALTH · PI Yanming Li · 2017 to 2026
$25.1M
Safe Cardiometabolic Drug Prescribing to Prevent Injury in Nursing Home ResidentsRF1AG061221 · NIA · HEBREW REHABILITATION CENTER FOR AGED · PI BERRY, SARAH DYER · 2019 to 2019
$2.8M
Medications and the Risk of Motor Vehicle Crashes in Older AdultsR01AG065722 · NIA · BROWN UNIVERSITY · PI ZULLO, ANDREW REIS · 2020 to 2023
$2.1M
A Clinical Prediction Tool to Guide Treatment of Osteoporosis in the Nursing HomeR01AG045441 · NIA · HEBREW REHABILITATION CENTER FOR AGED · PI BERRY, SARAH DYER · 2014 to 2017
$1.7M
Opioid use in post-acute hip fracture care: prescribing patterns, effectiveness, and safetyR21AG061632 · NIA · BROWN UNIVERSITY · PI BEAUDOIN, FRANCESCA, ZULLO, ANDREW REIS · 2019 to 2020
$462k
ANALYSIS OF THE K1LC GENE OF PROMISCUOUS PLASMID RK2F32GM011567 · NIGMS · COLUMBIA UNIV NEW YORK MORNINGSIDE · PI GONCHAROFF, PAUL · 1987 to 1989
–
NIA NIH HHS R01 AG045441NIA NIH HHS R01AG045441NIA NIH HHS R01 AG065722NIA NIH HHS R01AG065722NIA NIH HHS R21 AG061632NIA NIH HHS R21AG061632NIA NIH HHS RF1 AG061221NIA NIH HHS RF1AG061221NIGMS NIH HHS P20 GM121301NIGMS NIH HHS U54 GM115516NIGMS NIH HHS U54 GM115677NIGMS NIH HHS U54GM1156775Office of Academic Affiliations, Department of Veterans Affairs N/A
6 · The paper itself

Abstract

The comparative effects of zoledronic acid, denosumab, and teriparatide for preventing hip fractures in frail older adults, especially those in nursing homes, were unknown. We found that denosumab and zoledronic acid may be as effective as teriparatide for hip fracture prevention in nursing home residents.

introductionSeveral non-oral drugs exist for osteoporosis treatment, including zoledronic acid (ZA), denosumab, and teriparatide. Little data exist on the comparative effectiveness of these drugs for hip fracture prevention in frail older adults. We examined their comparative effectiveness in one of the frailest segments of the US population-nursing home (NH) residents.

methodsWe conducted a national retrospective cohort study of NH residents aged ≥ 65 years using 2012 to 2016 national US Minimum Data Set clinical assessment data and linked Medicare claims. New parenteral ZA, denosumab, and teriparatide use was assessed via Medicare Parts B and D; hip fracture outcomes via Part A; and 125 covariates for confounding adjustment via several datasets. We used inverse probability weighted (IPW) competing risk regression models to compare hip fracture risk between groups with teriparatide as the reference.

resultsThe study cohort (N = 2019) included 1046 denosumab, 578 teriparatide, and 395 ZA initiators. Mean age was 85 years, 90% were female, and 68% had at least moderate functional impairment. Seventy-two residents (3.6%) had a hip fracture and 1100 (54.5%) died over a mean follow-up of 1.5 years. Compared to teriparatide use, denosumab use was associated with a 46% lower risk of hip fracture (HR 0.54, 95% CI 0.29-1.00) and no difference was observed for ZA (HR 0.70, 95% CI 0.26-1.85).

conclusionsDenosumab and ZA may be as effective as teriparatide for hip fracture prevention in frail older adults. Given their lower cost and easier administration, denosumab and ZA are likely preferable non-oral treatments for most frail, older adults.

Indexed as

Bone Density Conservation AgentsOsteoporosisAgedAged, 80 and overCohort StudiesDenosumabFemaleFrail ElderlyHumansMaleMedicareRetrospective StudiesTeriparatideUnited StatesZoledronic AcidBone Density Conservation AgentsDenosumabTeriparatideZoledronic AcidComparative effectiveness researchDenosumabHip fracturesNursing homesTeriparatideZoledronic acid

Identifiers

PMID33411003
PMCPMC7933063
OpenAlexW3120738196

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.