After a minor fall breaks a bone, people who started the twice-yearly shot denosumab had fewer repeat breaks than those on bisphosphonates, a study of 15,099 adults finds
Death rates were about the same with either drug. But denosumab doses must come on time every six months, and stopping it takes a plan, the researchers warn.
Adults 50 and older who started the bone drug denosumab after breaking a bone in a minor accident were less likely to break another bone over the next three years than people who started a bisphosphonate, a widely used type of bone drug, according to a study published Nov. 11 in JAMA Network Open. Death rates were about the same with either drug.
What the study found
- Over three years, the chance of another break was 13% higher for women who started a bisphosphonate and 19% higher for men. That works out to about 1.7 more breaks for every 100 women and 3 more for every 100 men.
- The difference came mainly from breaks of bones other than the hip or spine, which make up more than 75% of all fractures. For hip and spine breaks, the risk was about the same with either drug.
- Deaths were similar: about 48 per 1,000 women a year on either drug, and 116 to 123 per 1,000 men.
What it means for patients
A bone broken in a minor accident, called a low-trauma fracture, often signals weak bones, and the risk of another break and of death is highest in the period right after it, the researchers wrote. Both drug types slow the breakdown of bone. Bisphosphonates include alendronate and risedronate, taken as pills, and zoledronic acid, given by IV. Denosumab is a shot given every six months.
The researchers said denosumab may help most for people at high risk of another break soon, or who are unlikely to keep taking bisphosphonate pills. But it comes with strings: doses delayed past the six-month mark are linked to a rebound in spine fractures, and anyone who stops denosumab needs a planned switch to a bisphosphonate. People who have broken a bone in a minor fall can ask their doctor whether they need a bone drug and which one fits them.
How the study worked
Researchers at the Garvan Institute of Medical Research in Sydney used linked health records from New South Wales, Australia, for 15,099 people, average age 77 and 83% women, who started one of the drugs within a year of a break between 2011 and 2018. They used statistics to make the two groups comparable and mimic a clinical trial. Patients were not randomly assigned a drug, so other differences between them could affect the results.