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All patients received standardized denosumab therapy (120\u00a0mg subcutaneously every 4\u00a0weeks\u2009\u00b1\u20097\u00a0days). Baseline demographic, laboratory, and treatment response data were extracted from the electronic medical record system. Univariate analyses were used to screen candidate variables, followed by multivariate logistic regression to identify independent predictors. Model fit was assessed using the Hosmer\u2013Lemeshow test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 111 patients were included (median age, 65.5\u00a0years; 50.45% male). During follow-up, 27 patients (24.3%) experienced SREs. Multivariate analysis identified a prior history of bisphosphonate use as an independent protective factor against SREs (odds ratio [OR], 0.191; 95% confidence interval [CI], 0.049\u20130.741 P\u2009=\u20090.017), while Pretreatment hypocalcemia and smoking were both significantly associated with increased risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study\u00a0is the first to demonstrate in a county-level hospital cohort\u00a0that a history of bisphosphonate use serves as an independent protective factor against SREs during denosumab treatment, while Pretreatment hypocalcemia and smoking history significantly increase SREs risk. These findings provide critical evidence for individualized management of stage IV lung adenocarcinoma patients with bone metastases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-025-10296-0","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T21:58:21Z","timestamp":1767736701000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for skeletal-related events in patients with stage IV lung adenocarcinoma and bone metastases receiving denosumab: a retrospective cohort analysis"],"prefix":"10.1007","volume":"34","author":[{"given":"Hui","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daochen","family":"Wen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhou","family":"Liao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyong","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianxia","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"issue":"3","key":"10296_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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