Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture: a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)
Authors' conclusion
In population-wide real-world data, women exposed to bisphosphonates and denosumab had a lower hip fracture risk than the unexposed population after adjusting for comorbidity.
Study context
- Population
- Norwegian women aged 50–89 in 2005–2016 (Norwegian prescription database (NorPD) prescription data; all hospital-treated hip fractures)
- Participants
- 1,044,661 women
- Exposure
- Bisphosphonate or denosumab use vs unexposed population
- Bisphosphonaten = 77,755
- Denosumabn = 4,483
- Outcome
- First-time hip fracture
Methodological detailsflexible parametric survival analysis, time-varying exposure, adjusted for Rx-Risk Comorbidity Index (time-varying)
- Flexible parametric survival analysis
- Time-varying exposure
- Adjusted for Rx-Risk Comorbidity Index (time-varying)
Main finding
As reported in the abstract
First-time hip fracture, fully adjusted
Each group vs unexposed populationHazard ratio (95% CI)
Bisphosphonate
0.95(0.91–0.99)
Denosumab
0.60(0.47–0.76)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Hip fracture in denosumab users with previous bisphosphonate useDenosumab after previous bisphosphonatevs Unexposed populationLowest fracture risk | 0.42 (0.29–0.61) | |
| 0.20.5125Hazard ratio (log scale) |
Hip fracture by treatment duration
- Bisphosphonate: significantly reduced risk vs population after 3 years
- Denosumab: significantly reduced risk vs population after 6 months
Original publication
Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture: a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Osteoporos Int. Published 27 April 2023. doi:10.
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