Cardiovascular and Fracture Risk with Denosumab Versus Bisphosphonates in Dialysis Patients Save
Annals of Internal Medicine has published a Japanese administrative claims database study showing that, compared with oral bisphosphonates (BIS), denosumab (DEN) lowered fracture risk by 45%, but increased the risk for major adverse cardiac events (MACE) by 36%.
Cardiac concerns are heightened in dialysis patients, who also have high rates of fracture morbidity. Hence, optimal management strategies are needed.
An observational target trial emulation was used to assess the risk for cardiovascular events and fracture prevention effects with denosumab compared with oral bisphosphonates in dialysis-dependent patients. Researchers studied adults aged 50 years or older who have initiated denosumab or oral bisphosphonates for osteoporosis in dialysis-dependent patients. The safety outcome was major adverse cardiac events (MACE). The effectiveness outcome was a composite of all fractures. Follow-up was 3 years.
The study included 1032 dialysis patients (658 denosumab users and 374 oral bisphosphonate users) who were older (average age was 74.5 years), and 63% were women.
The 3-year risk difference for MACE was 8.2% (comparing DEN vs BIS), with a weighted 3-year risk ratio of 1.36 (CI, 0.99 to 1.87) favoring DEN. The 3-year risk difference for composite fractures was –5.3%, and the weighted 3-year risk ratio was 0.55 (CI, 0.28 to 0.93), favoring DEN.
This study did not look at renal status, osteoporosis severity or other CV risk factors. Hence, the influence of these confounders require future study.
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