ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026
Pre-teriparatide anti-osteoporosis medication therapy and fracture-related hospitalization in patients at very high fracture risk.
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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This study evaluated whether prior anti-osteoporosis medication (AOM) use influences fracture risk in patients at very high fracture risk who subsequently initiated teriparatide. Using a nationwide cohort of 14,770 patients, participants were categorized based on prior AOM exposure. Bisphosphonate was associated with decreased both fracture and spinal fracture-related hospitalization, while the decreased risk was not shown in denosumab users. Long-term denosumab use (≥ 3 years) was associated with a significantly increased risk of spine fracture-related hospitalization after transitioning to teriparatide. PURPOSE: To evaluate whether prior AOM use, including type and duration, affects fracture-related hospitalization in patients at very high fracture risk initiating teriparatide.
methodsThis nationwide cohort study used Taiwan's National Health Insurance Research Database (2013-2019) to examine 14,770 patients. Patients were categorized by prior AOM use (yes vs no), AOM type (bisphosphonates vs denosumab vs raloxifene; denosumab vs non-denosumab), and denosumab duration (≥ 3 vs < 3 years). The primary outcome was hospitalization for major osteoporotic fractures within 3 years.
results9,127 participants received AOM treatment within 2 years prior to teriparatide initiation, whereas 5,643 did not. There was no statistically significant difference in fracture-related hospitalizations between the AOM and non-AOM groups (HR = 0.92; 95% CI 0.83-1.02; p = 0.102). However, the HR for spinal fracture-related hospitalization was lower in the AOM treatment group (HR = 0.85; CI 0.73 to 0.98; p = 0.026).] Bisphosphonate was associated with decreased both fracture and spinal fracture-related hospitalization, (HR = 0.85, 95% CI = 0.75-0.96 for fracture; HR = 0.83, 95% CI = 0.76-0.91 for spinal fracture), while the decreased risk was not shown in denosumab users. Noteworthy, patients who had used denosumab for ≥ 3 years before switching to teriparatide had a significantly higher risk of spine fracture--related hospitalizations (adjusted HR 1.86, p = 0.011), particularly within the first 6 months of transitioning (adjusted HR 1.98, p = 0.031).
conclusionPrior AOM therapy was not associated with an increased fracture-related hospitalization risk after starting teriparatide in patients at very high fracture risk. However, among those who used AOM before teriparatide initiation, long-term denosumab use (≥ 3 years) was associated with an increased risk of spine fracture-related hospitalization. Further research is warranted to optimize sequential therapy strategies among patients under long-term denosumab use.
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