ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Bone Research
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1590472
This article is part of the Research TopicMetabolic and Biomechanical Factors in Bone Fragility: New Frontiers in Understanding and Managing OsteoporosisView all articles
Zoledronic Acid and Denosumab are associated with similar fracture incidence and mortality in patients with type 2 diabetes: a population-based cohort study
Provisionally accepted
- 1Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- 2Tel Aviv University, Tel Aviv, Tel Aviv, Israel
- 3Maccabi Health Care Services, Tel Aviv, Israel
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Purpose: To assess the comparative effectiveness of zoledronic acid vs. denosumab in prevention of major osteoporotic fractures and mortality among patients with type 2 diabetes. Methods: The study population was identified by crosslinking the diabetes and osteoporosis registries of a large healthcare organization in Israel. Demographics, Charlson Comorbidity Index (CCI), diabetes complications, bone mineral density (BMD) T-scores, haemoglobin A1c levels, eGFR, purchase of statins and anti-resorptive agents were collected. Exposure groups were matched using propensity score. Kaplan-Meier curves were generated to assess the time from treatment initiation to outcomes. Multivariable Cox's proportional hazards survival models estimated hazard ratios (HR) and 95% CIs for each outcome. Results: Among 27503 patients with concurrent osteoporosis and type 2 diabetes, 627 (4.7%) received zoledronic acid and 502 (3.7%) denosumab. Prior to matching, the denosumab-treated patients were older (mean age 75.7 vs 71.9, p<0.01), had longer diabetes duration (mean 8.4 vs 7.2 years, p<0.01), and had a lower baseline eGFR (59.4 vs 75.3, p<0.01) than the zoledronic acid-treated patients. After matching, 415 pairs of subjects were included. The incidence of all examined outcomes was similar in the Zol and Dmab treatment groups, including 5-year cumulative incidence of fractures (38% vs 31%), death events (36% vs 41%), overall fracture risk (HR=1.17, 95% CI: 0.78 to 1.75), death risk (HR= 1.12, 95% CI:0.87 to 1.44), and mortality after a hip fracture (HR= 0.92, 95% CI:0.37-2.29). Conclusions: Our findings suggest comparability of Zoledronic Acid and Denosumab in managing osteoporotic fractures and mortality among patients with type 2 diabetes.
Keywords: Anti-resorptive treatment, type 2 diabetes, Osteoporosis, fracture prevention, Mortality
Received: 09 Mar 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 Rouach, Gortler, Greenman, Chodick and Goldshtein. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Vanessa Rouach, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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