Zullo A R, Lee Y, Lary C, Daiello L A, Kiel D P, Berry S D
Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA.
Osteoporos Int. 2021 Mar;32(3):565-573. doi: 10.1007/s00198-020-05732-2. Epub 2021 Jan 7.
The comparative effects of zoledronic acid, denosumab, and teriparatide for preventing hip fractures in frail older adults, especially those in nursing homes, were unknown. We found that denosumab and zoledronic acid may be as effective as teriparatide for hip fracture prevention in nursing home residents.
Several non-oral drugs exist for osteoporosis treatment, including zoledronic acid (ZA), denosumab, and teriparatide. Little data exist on the comparative effectiveness of these drugs for hip fracture prevention in frail older adults. We examined their comparative effectiveness in one of the frailest segments of the US population-nursing home (NH) residents.
We conducted a national retrospective cohort study of NH residents aged ≥ 65 years using 2012 to 2016 national US Minimum Data Set clinical assessment data and linked Medicare claims. New parenteral ZA, denosumab, and teriparatide use was assessed via Medicare Parts B and D; hip fracture outcomes via Part A; and 125 covariates for confounding adjustment via several datasets. We used inverse probability weighted (IPW) competing risk regression models to compare hip fracture risk between groups with teriparatide as the reference.
The study cohort (N = 2019) included 1046 denosumab, 578 teriparatide, and 395 ZA initiators. Mean age was 85 years, 90% were female, and 68% had at least moderate functional impairment. Seventy-two residents (3.6%) had a hip fracture and 1100 (54.5%) died over a mean follow-up of 1.5 years. Compared to teriparatide use, denosumab use was associated with a 46% lower risk of hip fracture (HR 0.54, 95% CI 0.29-1.00) and no difference was observed for ZA (HR 0.70, 95% CI 0.26-1.85).
Denosumab and ZA may be as effective as teriparatide for hip fracture prevention in frail older adults. Given their lower cost and easier administration, denosumab and ZA are likely preferable non-oral treatments for most frail, older adults.
唑来膦酸、地诺单抗和特立帕肽在预防体弱老年人尤其是养老院老人髋部骨折方面的比较效果尚不清楚。我们发现，地诺单抗和唑来膦酸在预防养老院居民髋部骨折方面可能与特立帕肽同样有效。
有几种非口服药物可用于治疗骨质疏松症，包括唑来膦酸（ZA）、地诺单抗和特立帕肽。关于这些药物在预防体弱老年人髋部骨折方面的比较效果的数据很少。我们在美国最体弱的人群之一——养老院（NH）居民中研究了它们的比较效果。
我们利用2012年至2016年美国国家最小数据集临床评估数据和相关的医疗保险理赔记录，对年龄≥65岁的NH居民进行了一项全国性回顾性队列研究。通过医疗保险B部分和D部分评估新使用的肠外ZA、地诺单抗和特立帕肽；通过A部分评估髋部骨折结局；通过几个数据集评估125个协变量以进行混杂因素调整。我们使用逆概率加权（IPW）竞争风险回归模型，以特立帕肽为参照比较各组之间的髋部骨折风险。
研究队列（N = 2019）包括1046名地诺单抗使用者、578名特立帕肽使用者和395名ZA使用者。平均年龄为85岁，90%为女性，68%至少有中度功能障碍。在平均1.5年的随访期内，7
