# Adherence to denosumab therapy and all-cause mortality in dialysis patients with osteoporosis: a retrospective cohort exploratory study

## TL;DR

This study found that better adherence to denosumab therapy is linked to lower mortality in dialysis patients with osteoporosis.

## Contribution

The study explores the relationship between denosumab adherence and mortality in dialysis patients with osteoporosis.

## Key findings

- Poor adherence to denosumab was found in 50% of deceased patients versus 7.5% of survivors.
- Good adherence to denosumab therapy was associated with lower all-cause mortality risk.
- Older age and poor adherence were significantly associated with higher mortality in Cox regression analysis.

## Abstract

Dialysis patients have a high risk of osteoporosis, leading to increasedfracture and mortality rates. Denosumab is commonly used in thispopulation due to its lack of renal accumulation, but its long-termbenefit depends on sustained adherence. This This exploratory study investigated therelationship between denosumab adherence and all-cause mortality indialysis patients with osteoporosis.

This retrospective case--control study included 1,200 hemodialysis patients. Four hundred deceased patientswere matched 1:3 by age, sex, and follow-up duration to 1,200 survivingcontrols. Adherence to denosumab therapy was calculated, and itsassociation with mortality was assessed using Cox regression analysis.

Among 401 denosumab-treated patients, 12 died and 389 survived duringfollow-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% ofdeceased patients versus 7.5% of survivors (*p* <0.001).Comorbidities, including diabetes, hypertension, rheumatoid arthritis, liver disease, pulmonary disease, and cancer, differed significantlybetween 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.

Good adherence to denosumab therapy was associated with lower all-causemortality risk in dialysis patients withosteoporosis. 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.

Schematic representation of the relationship between adherence to denosumab therapy and survival outcomes in dialysis patients with osteoporosis. Patients receiving denosumab were categorized into good adherence and poor adherence groups. Good adherence was associated with improved survival, whereas poor adherence was associated with increased mortality.Flowchart illustrating dialysis patients with osteoporosis receiving Denosumab therapy. Good adherence leads to better survival, while poor adherence results in higher mortality. Black, blue, and red arrows depict these pathways.

Schematic representation of the relationship between adherence to denosumab therapy and survival outcomes in dialysis patients with osteoporosis. Patients receiving denosumab were categorized into good adherence and poor adherence groups. Good adherence was associated with improved survival, whereas poor adherence was associated with increased mortality.