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In addition, predictors of adherence-related treatment discontinuation were evaluated for TPTD and ALN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Japanese women aged\u2009\u2265\u200975\u00a0years with primary osteoporosis and high fracture risk were randomized to either sequential therapy (TPTD for 72\u00a0weeks followed by ALN for 48\u00a0weeks) or ALN monotherapy for 120\u00a0weeks. Cognitive frailty was defined as an MMSE score\u2009\u2264\u200927, and physical frailty as requiring support or nursing care. Vertebral, non-vertebral, and all fractures were assessed. Adherence-related discontinuations were identified, and baseline predictors were analyzed using multiple regression to calculate odds ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 514 patients with cognitive frailty (254 with TPTD, 260 with ALN) and 204 patients with physical frailty (109 with TPTD, 95 with ALN) were identified. In patients with cognitive frailty, vertebral fracture incidence tended to be lower with TPTD (rate ratio 0.72), but not significantly. In patients with physical frailty, the incidence was significantly lower with TPTD (rate ratio 0.50,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Dyslipidemia and serum calcium levels were significant predictors of TPTD discontinuation, whereas cognitive impairment and dyslipidemia were predictors for ALN discontinuation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with physical frailty, TPTD reduced vertebral fractures significantly more than ALN. However, in cases with cognitive impairment, the results of the JOINT-05 study may not necessarily apply. Assessing the presence of dyslipidemia and cognitive decline may be useful for predicting adherence-related discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>jRCTs031180235 and UMIN000015573, March 12, 2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00774-025-01610-1","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T15:51:07Z","timestamp":1748361067000},"page":"448-457","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Evaluation of the fracture prevention effects of teriparatide and alendronate in patients with frailty: a sub-analysis of the Japanese osteoporosis intervention trial-05"],"prefix":"10.1007","volume":"43","clinical-trial-number":[{"clinical-trial-number":"umin000015573","registry":"10.18810\/umin-japan"}],"author":[{"given":"Tatsuya","family":"Hosoi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Yunoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Hagino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Soen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5935-276X","authenticated-orcid":false,"given":"Sumito","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"1610_CR1","first-page":"843","volume-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group","author":"WHO Study group","year":"1994","unstructured":"WHO Study group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group. 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M Yunoki declare no competing interests. S Tanaka has received lecture fee from Bayer Japan, MSD K.K., Amgen Astellas BioPharma K.K., JMDC Inc. and Research Institute of Healthcare Data Science. He has received consultation fee from Boehringer Ingelheim and Daiichi Sankyo Co., Ltd. He has received outsourcing fee from Public Health Research Foundation. He has received research grants from the Japan Agency for Medical Research and Development, the Japanese Ministry of Health, Labour and Welfare, the Japanese Ministry of Education, Science and Technology, and Novo Nordisk. He engaged in a research project of the Japan Agency for Medical Research and Development. H Hagino received lecture fees or grants outside the submitted work from Amgen Inc., Asahi Kasei Pharma Corp., Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Mochida Pharma Co., Ltd., Teijin Pharma Ltd., and UCB Japan Co., Ltd. S Mori declare no competing interests. S Soen has received consulting fees, speaking fees, and\/or honoraria from Amgen Inc., Asahi Kasei Pharma Corp., Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan Co., Ltd., Mochida Pharma Co., Ltd., Ono Pharmaceutical Co., Ltd., Teijin Pharma Ltd., and UCB Japan Co., Ltd. S Ogawa declares no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}