No difference in fracture risk with denosumab vs alendronate
medwireNews: Patients initiating denosumab have a similar 3-year fracture risk to those initiating alendronate, regardless of sex, age, or fracture history, show results of a large study among Danish patients in routine clinical practice.
The study included 92,355 individuals (81% women) aged 50 years or older (mean 71 years) who started treatment with denosumab (n=4624) or alendronate (n=87,731) between 2010 and 2017.
At 3 years, the cumulative incidence of hip fracture was 3.7% among the people receiving denosumab and 3.1% among those receiving alendronate, while the incidence of any fracture was 9.0% in both groups.
After weighting the data by stabilized inverse probability of treatment, derived from propensity scores, to adjust for potential confounders, the researchers found no significant difference in the rates of hip or any fracture for denosumab versus alendronate.
Subgroup analyses also showed that there was no difference in hip fracture risk between the two treatments according to age, sex, and fracture history.
By contrast, people younger than 80 years, women, those with and without a history of any fracture, and those with no history of hip fracture had significantly lower risks for any fracture with denosumab than with alendronate, at adjusted hazard ratios of, 0.85, 0.89, 0.77, 0.84, and 0.89, respectively.
Writing in JAMA Network Open, Alma Pedersen (Aarhus University Hospital, Denmark) and colleagues note that their “finding of no clinically relevant differences between denosumab and alendronate in the risk of hip and any fracture is in line with findings of the [randomized controlled trials],” which also “showed greater efficacy of denosumab vs alendronate in improving bone mineral density [BMD].”
The authors continue: “It is well known that BMD can identify individuals who are at increased risk of developing a fracture, but it cannot with certainty identify individuals who will eventually develop fractures.
“Therefore, it is important to use data from clinical practice to examine treatment effectiveness in terms of fracture risk (clinically relevant outcome).”
Pedersen et al conclude: “The cost-effectiveness of denosumab treatment compared with alendronate is an argument for prescribing denosumab rather than alendronate to prevent hip fractures.”
By Laura Cowen
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