ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Adherence to Denosumab Therapy and All-Cause Mortality in Dialysis Patients with Osteoporosis: A Retrospective Cohort Exploratory Study
Provisionally accepted
- 1Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- 2Kaohsiung Chang Gung Memorial Hospital, Niaosong District, Taiwan
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Background Dialysis patients have a high risk of osteoporosis, leading to increased fracture and mortality rates. Denosumab is commonly used in this population due to its lack of renal accumulation, but its long-term benefit depends on sustained adherence. This This exploratory study investigated the relationship between denosumab adherence and all-cause mortality in dialysis patients with osteoporosis. Methods This retrospective case--control study (revised for consistency) included 1,200 hemodialysis patients. Four hundred deceased patients were matched 1:3 by age, sex, and follow-up duration to 1,200 surviving controls. Adherence to denosumab therapy was calculated, and its association with mortality was assessed using Cox regression analysis. Results Among 401 denosumab-treated patients, 12 died and 389 survived during follow-up. The deceased group was older than survivors (85.0 ± 11.07 vs. 75.87 ± 10.24 years, *p* = 0.016). Poor adherence occurred in 50% of deceased patients versus 7.5% of survivors (*p* < 0.001). Comorbidities, including diabetes, hypertension, rheumatoid arthritis, liver disease, pulmonary disease, and cancer, differed significantly between groups. In Cox regression analysis, older age (HR = 1.137, 95% CI = 1.044--1.239) and poor adherence (HR = 0.065, 95% CI = 0.015--0.288) were significantly associated with higher mortality. Conclusions Good adherence to denosumab therapy was associated with lower all-cause mortality risk (revised phrasing) in dialysis patients with osteoporosis. Improving treatment adherence may enhance survival in this high-risk population. Given the exploratory nature of this study and the limited number of events, these findings require validation in larger cohorts.
Keywords: Medication Adherence, All-cause mortality, Osteoporosis, Dialysis, denosumab therapy
Received: 19 Sep 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Chen, Chiu, Chen, Yu and Hsu. 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: Ying-Chou Chen, r820713@ms13.hinet.net
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