Objectives: Osteoporosis is a common complication in patients undergoing long-term corticosteroid therapy, particularly those with rheumatological and immunological conditions. Denosumab has shown potential in enhancing bone density and reducing fracture risk in such patients. This study evaluates the effectiveness of denosumab in osteoporosis management among corticosteroid-treated individuals. Methods: Between 2013 and 2022, 390 osteoporosis patients who received denosumab (60 mg subcutaneously every 6 months) for ≤18 months were enrolled. Patients were categorized based on corticosteroid use, and age-matching was applied to ensure comparability. Bone mineral density (BMD) and trabecular bone score (TBS) at the lumbar spine and femoral neck were assessed, and secondary fractures during the follow-up period were recorded. Results: Over the 18-month follow-up, both groups showed improvements in lumbar spine T-scores. The corticosteroid group increased from −2.1 ± 1.2 to −2.0 ± 1.3 (p < 0.001), while the non-corticosteroid group improved from −2.6 ± 1.2 to −2.4 ± 1.2 (p = 0.003). However, logistic regression analysis revealed that corticosteroid use remained a significant risk factor for secondary fractures (odds ratio: 1.69; 95% confidence interval: 1.11–2.56, p = 0.014), despite denosumab treatment. Conclusions: This retrospective study observed stabilization and a modest increase in BMD and TBS among corticosteroid users. Although differences in secondary fractures persisted between groups, denosumab shows potential for managing corticosteroid-induced osteoporosis. The study’s focus on Taiwanese patients limits its generalizability, and future research should include diverse populations to enhance applicability.

Background and Objectives: Osteoporosis poses significant health risks, especially among veterans, due to lifestyle factors. This study compares bone density and fracture risks between male veterans and non-veterans. Materials and Methods: We conducted a retrospective analysis of 1427 veterans from the Taichung Veterans General Hospital osteoporosis database (2010–2022), matched 1:1 by age and gender with non-veterans. Bone mineral density (BMD) was measured via dual-energy X-ray absorptiometry (DXA). Comorbidities, fracture sites, and mortality data were tracked. Conditional logistic regression was used to identify factors influencing fracture risk. Results: The study found that veterans have a higher fracture risk (univariable OR 1.24, multivariable OR 1.20, p < 0.001). Fracture victims were slightly younger in the veterans group (78.7 ± 10.0 years vs. 80.1 ± 9.2 years, p = 0.010), who also had better T-scores in the lumbar spine and left femoral neck. Veterans showed a higher post-fracture mortality rate (39.9% vs. 31.9%, p = 0.001) and a greater incidence of radial fractures (5.01% vs. 2.96%, p = 0.036). Importantly, veterans exhibited a trend toward more hip fractures compared with non-veterans (27.0% vs. 23.6%, p = 1.017), suggesting a potential difference despite not reaching statistical significance. Conclusions: In the present study, we found that veterans have higher rates of comorbidities, and higher mortality after a fracture event, highlighting the need for targeted medical interventions to address these differences. Further intervention to prevent avoidable fractures and the provision of adequate care for long-term osteoporosis management remain critical issues.

Background and Objective: Romosozumab carries a warning for potential severe cardiovascular events, while denosumab is widely used for osteoporosis but requires safety considerations in advanced chronic kidney disease (CKD). Given the limited direct real-world evidence comparing these treatments, in this study, we aimed to compare the cardiovascular and survival outcomes associated with romosozumab versus denosumab in adults with CKD. Materials and Methods: In this retrospective propensity score-matched cohort study, we utilized de-identified electronic health records from the TriNetX Global Collaborative Network, where eligible participants were adults aged 40 to 90 years with CKD who initiated either romosozumab or denosumab. Patients with bone/bone marrow malignancies or recent acute cardiovascular events were excluded. Following 1:1 propensity score matching based on demographics, diagnoses, medications, and laboratory characteristics, patients were followed for up to 1095 days. The primary outcome was a composite cardiovascular measure (all-cause mortality, acute myocardial infarction, or cerebrovascular event), while secondary outcomes included the individual components of the composite outcome and acute heart failure. Outcomes were evaluated using fixed-window cumulative risks, risk ratios (RRs), odds ratios, and hazard-ratio estimates. Results: After 1:1 propensity score matching, 1201 patients remained in each cohort; the mean age was 74.1 years in the romosozumab cohort and 74.2 years in the denosumab cohort, and 94.9% and 93.8%, respectively, were women. Romosozumab was associated with lower 1095-day cumulative risk of the composite cardiovascular outcome than denosumab (12.6% vs. 18.8%; RR, 0.668 [95% CI, 0.553–0.808]), as well as lower cumulative risk of cerebrovascular event (5.0% vs. 7.0%; RR, 0.714 [95% CI, 0.518–0.985]), all-cause mortality (6.6% vs. 9.5%; RR, 0.693 [95% CI, 0.526–0.913]), acute myocardial infarction (3.8% vs. 6.2%; RR, 0.613 [95% CI, 0.429–0.878]), and heart failure (2.7% vs. 6.1%; RR, 0.438 [95% CI, 0.292–0.659]). Conclusions: In this propensity score-matched EHR cohort of adults with CKD, cardiovascular and survival estimates associated with romosozumab versus denosumab varied by follow-up window and analytic approach. Although 1095-day fixed-window cumulative risks were lower in the romosozumab cohort, corresponding time-to-event estimates were neutral or directionally inconsistent. These findings should not be interpreted as evidence of cardioprotection or causal superiority but rather as showing no clear and consistent excess cardiovascular risk signal for romosozumab compared with denosumab.