Bisphosphonates linked to more repeat fractures than denosumab
Women starting bisphosphonates had 52.7 repeat fractures per 1,000 person-years, versus 46.5 with denosumab, during three years of follow-up.
Our read
Interventions- Studied:
- Cohort study of 15,099 adults with recent low-trauma fractures, against patients starting denosumab
- What changed:
- Women starting bisphosphonates had more repeat fractures: 52.7 versus 46.5 per 1,000 person-years with denosumab
- The catch:
- Health differences between people prescribed the medicines could account for the fracture difference
Editor of record: Boris Djordjevic · AgingResearch.News
15,099 adults aged 50 or older in New South Wales, Australia, started either nitrogen-containing bisphosphonates or denosumab within 12 months after a low-trauma fracture. Both medicines slow bone breakdown. The cohort study used health records to emulate monthly trials, with three years of follow-up. Participants included 12,529 women and 2,570 men; their overall average age was 77.2.
Starting bisphosphonates was associated with more repeat fractures in both sexes, particularly after fractures outside the hip or spine. Men's repeat-fracture rates were 70.5 with bisphosphonates versus 58.8 with denosumab per 1,000 person-years. Death rates showed no clear difference: 48.1 versus 48.9 in women and 123.0 versus 116.4 in men, respectively, per 1,000 person-years. These rates count events relative to the total time people were followed.
Why it matters
Older adults face high risks of another fracture and death after a low-trauma fracture. Comparing these medicines can inform decisions about care during that high-risk period.
Caveats
Health differences between people prescribed the two medicines could have contributed to the fracture comparison. The findings concern adults aged 50 or older who started medication after a low-trauma fracture.
The paper
Bisphosphonates vs Denosumab After Low-Trauma Fractures
Clinical and Translation Science Laboratory
JAMA Network Open, Nov 11, 2026
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