Pre-teriparatide anti-osteoporosis medication therapy and fracture-related hospitalization in patients at very high fracture risk.

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. To evaluate whether prior AOM use, including type and duration, affects fracture-related hospitalization in patients at very high fracture risk initiating teriparatide. This 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. 9,127 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). Prior 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.