Increased osteoporosis burden and comparative antiresorptive effectiveness in inflammatory bowel disease: a real-world cohort study
Main finding · New osteoporosis diagnosisResult — go to the resultAdjusted odds ratio 1.58 95% CI 1.51–1.65Authors' conclusion
IBD confers a substantially higher and multifactorial osteoporosis risk. Denosumab showed similar observed short-term fracture rates to bisphosphonates, although clinically meaningful differences could not be excluded.
Study context
- Population
- Adults with inflammatory bowel disease (IBD) in the US TriNetX network (mean age 44.2 y; 51.8% female)2 cohorts: 143,248 IBD
- Exposure
- IBD vs non-IBD controls; denosumab vs bisphosphonates in IBD with osteoporosis
- IBDn = 143,248
- Denosumabn = 520
- Bisphosphonatesn = 1,903reference
- Outcome
- New osteoporosis diagnosis
- Follow-up
- 5 years
Methodological detailspropensity-score matched (1:1), two cohorts, US TriNetX network
- Propensity-score matched (1:1)
- Two cohorts
- US TriNetX network
Main finding
As reported in the abstract
1 year
Adjusted odds ratio
1.58
95% CI 1.51–1.65
IBDvs Non-IBD controls
aOR 1.58 (95% CI 1.51–1.65)
Observational data: associations, not effects.
Further findings
| Outcome | Denosumab | Bisphosphonates | aOR | |
|---|---|---|---|---|
| New osteoporosis diagnosis, Crohn's disease (CD) · 1 yearIBDvs Non-IBD controlsCD | 1.79 (95% CI 1.68–1.90) | |||
| New osteoporosis diagnosis, ulcerative colitis (UC) · 1 yearIBDvs Non-IBD controlsUC | 1.47 (95% CI 1.39–1.56) | |||
| Fracture rate, denosumabvs bisphosphonates · 1 yearAfter matching | 2.33% | 3.49% | 0.65 (CI 0.31–1.38) | |
| Fracture rate, denosumabvs bisphosphonates · 2 yearsAfter matching | 4.65% | 6.78% | 0.67 (CI 0.39–1.14) | |
| 0.20.5125Adjusted odds ratio (log scale) |
Determinants of osteoporosis risk (subgroups)
- Ulcerative colitis (UC): increased risk with age > 65, female sex and Asian race
- Crohn's disease (CD): increased risk with age > 65, female sex, nicotine dependence and alcohol use
Original publication
Increased osteoporosis burden and comparative antiresorptive effectiveness in inflammatory bowel disease: a real-world cohort study. Osteoporos Int. Published 17 April 2026. doi:10.
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