Osteoarthritis risk associated with denosumab in adults with osteoporosis: a target trial emulation
Authors' conclusion
Denosumab initiation was associated with a modestly lower risk of incident osteoarthritis than oral bisphosphonate initiation, although the association was weaker in the switch-continue comparison.
Study context
- Population
- Adults aged ≥50 years with osteoporosis, Japanese health insurance claims data 2015–2024
- Exposure
- Denosumab vs oral bisphosphonates
- Outcome
- Osteoarthritis incidence
- Follow-up
- 3 years
Methodological detailssequential nested target trial emulation, propensity score matching, longitudinal health insurance claims data
- Sequential nested target trial emulation
- Propensity score matching
- Longitudinal health insurance claims data
Main finding
As reported in the abstract
Incident osteoarthritis
- New-user comparison (denosumab vs oral bisphosphonates), per-protocol: Absolute risk reduction (ARR)
- 2.0% (95% CI, 1.1%-3.2%)
- New-user comparison (denosumab vs oral bisphosphonates), per-protocol: RR
- 0.83 (95% CI, 0.73-0.91)
- Switch-continue comparison, per-protocol: ARR
- 0.9% (95% CI, −0.2% to 2.8%)
- Switch-continue comparison, per-protocol: RR
- 0.92 (95% CI, 0.76-1.02)
- New-user comparison, ITT: ARR
- 1.9% (95% CI, 1.3%-3.3%)
- New-user comparison, ITT: RR
- 0.84 (95% CI, 0.73-0.89)
- Switch-continue comparison, ITT: ARR
- 1.2% (95% CI, −0.2% to 2.7%)
- Switch-continue comparison, ITT: RR
- 0.89 (95% CI, 0.77-1.02)
Observational data: associations, not effects.
Original publication
Osteoarthritis risk associated with denosumab in adults with osteoporosis: a target trial emulation. J Bone Miner Res. Published 22 July 2026. doi:10.
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