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Summary <p>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.</p> Purpose <p>To evaluate whether prior AOM use, including type and duration, affects fracture-related hospitalization in patients at very high fracture risk initiating teriparatide.</p> Methods <p>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 &lt; 3 years). The primary outcome was hospitalization for major osteoporotic fractures within 3 years.</p> Results <p>9,127 participants received AOM treatment within 2&#xa0;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; <i>p</i> = 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&#xa0;years before switching to teriparatide had a significantly higher risk of spine fracture–-related hospitalizations (adjusted HR 1.86, <i>p</i> = 0.011), particularly within the first 6&#xa0;months of transitioning (adjusted HR 1.98, <i>p</i> = 0.031).</p> Conclusion <p>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&#xa0;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.</p>

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

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Shao-Chi Fu,
  • Yi-Chien Lu,
  • Ning-Huei Sie,
  • Chih-Chien Hung,
  • Chung-Yi Li,
  • Rong-Sen Yang,
  • Shau-Huai Fu,
  • Chen-Yu Wang

摘要

Summary

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.

Purpose

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

Methods

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.

Results

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).

Conclusion

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.