Impact of Denosumab Adherence on Renal Function and Mortality Rates in Type 2 Diabetes Patients With Osteoporosis

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of osteoporosis and fractures, and denosumab, a non-kidney-excreted antiresorptive medication, represents a viable alternative to bisphosphonates for osteoporosis treatment in patients with T2DM. This study aimed to investigate the association among denosumab adherence, renal function, and all-cause mortality in patients with T2DM and osteoporosis. New denosumab users between 2010 and 2017 were identified from an electronic health record database, and after exclusion, 536 participants were screened and analyzed based on their 2-year drug adherence: high adherence (HA) defined as three or four doses, and low adherence (LA) defined as one or two doses. The 1-year average estimated glomerular filtration rate (eGFR) was calculated, and all-cause mortality was analyzed using Kaplan-Meier curves and Cox regression models. The study included 286 and 250 subjects in the HA and LA groups, respectively, and although eGFR declined in both groups, renal function remained comparable between the groups. The all-cause mortality rate was significantly lower in the HA group compared to the LA group (adjusted hazard ratio: 0.52, 95% confidence interval: 0.29-0.92). High denosumab adherence was found to be associated with a lower risk of all-cause mortality among patients with T2DM and osteoporosis without significantly impacting renal function, highlighting the potential benefits of maintaining regular denosumab treatment in this high-risk population. Nevertheless, this observational study design indicates association rather than causation, and further prospective research is warranted to validate these results and elucidate the mechanisms underlying the relationships observed in this study.