MON-815 Safety and efficacy of antiresorptive treatments in patients with obesity: a registry-based study.

Abstract Disclosure: V. Rouach: Amgen Inc, Teva Pharmaceutical Industries Ltd.. AbstractBackground: Despite the classic concept of obesity as a protective factor for fractures, recent evidence has shown that these patients are at increased risk of fractures. Obesity has been linked to compromised bone quality, and impaired bone healing, despite normal or even elevated bone mineral density (BMD) in some cases. Anti-resorptive treatments, including bisphosphonates and denosumab, have been the cornerstone of osteoporosis management, however, their efficacy on fracture prevention and mortality in patients with obesity remains less established. Aim: Evaluate the relationship between anti-resorptive therapy, fracture risk reduction and mortality in a population of patients with obesity. Methods and subjects: The study population was identified by electronic records of an osteoporosis registry of a large healthcare organization in Israel. Demographics, Comorbidity Index (CCI), bone mineral density (BMD) T-scores, purchase of anti-resorptive agents were collected. Exposure groups were matched using propensity score. Kaplan-Meier curves were generated to assess the time to outcomes. Multivariable Cox's proportional hazards survival model was performed. Results: Between January 1998 and December 2021 a total of 11604 patients with osteoporosis and a BMI above 30 were identified. The mean BMI was 34.6 (4.2), 37% had a BMI over 35. The mean age was 71.4 (8.3), 75.2% were women. The mean FN T-Score -1.6 (1.0), the mean eGFR was 67.9 (23.1), the mean CCI was 3.6 (2.6). A total of 5412 (46.6%) patients purchased an anti-resorptive agent: 3370 (62.2%) alendronate, 1562 (28.9%) risedronate, 270 (5%) zoledronic acid, and 210 (3.9%) denosumab. Compared to non-treated patients, before matching, the treated patients were slightly older (71.8 vs 70.8, p<0.01), had a lower FN T-Score (-1.7 vs -1.3, P<0.01), and a lower eGFR (65.2 vs 69.5, p<0.01). The proportion of women was higher (83% vs 68.7%) and falls were more frequent (24.2% vs 20.7%) in treated versus non-treated subjects. After matching, 607 pairs of subjects treated and non-treated remained. A total of 489 fractures were reported, 414 at the osteoporosis registry entry. The 5-year cumulative incidence of fracture and death events were 34.5% vs 50.4% and 13.6% vs 21.3% in the treated versus non-treated patients. The risk of fracture and death were HR=0.67 (0.55-0.81) and HR= 065 (0.48-0.88) respectively. Conclusions: Our findings suggest that anti-resorptive agents reduce osteoporotic fractures and mortality among obese patients, offering valuable insights for treatment strategies in this vulnerable population. Presentation: Monday, July 14, 2025