In a recent comparative study between the three most acceptable treatments for osteoporosis, denosumab and zoledronic acid (ZA) was found to be as effective as teriparatide for the prevention of hip fractures in frail elderly.A.R. Zullo et al. evaluated the comparative efficacy of denosumab, teriparatide and ZA in elderly patients, given their limited evidence for fracture prevention in elderly adults.

In this national retrospective cohort study, novel parenteral ZA, denosumab, and teriparatide usage was examined in ≥ 65 years old patients (mean age 85 years; 90% female patients, and 68% had at least moderate functional impairment). The inverse probability weighted competing risk regression models were helpful in distinguishing amongst the study groups with reference to teriparatide.

Out of total 2019 patients, denosumab, teriparatide and ZA was initiated in 1046, 578 and 395 patients, respectively. Over 1.5 years’ follow-up, hip fracture was reported by 72 patients (3.6%) and 1100 patients (54.5%) died. The use of denosumab was linked with a 46% lower hip fracture risk than teriparatide. No such difference was perceived in case of ZA.

Although denosumab and ZA may be as useful as teriparatide; these are expected to be ideal non-oral therapies for hip fractures considering their lower cost and ease of administration in elderly population, concluded the study authors.