{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:37:03Z","timestamp":1793399823090,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To assess the comparative effectiveness of zoledronic acid <jats:italic>vs<\/jats:italic>. denosumab in prevention of major osteoporotic fractures and mortality among patients with type 2 diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population was identified by crosslinking the diabetes and osteoporosis registries of a large healthcare organization in Israel. Demographics, Charlson Comorbidity Index (CCI), diabetes complications, bone mineral density (BMD) T-scores, hemoglobin A1c levels, eGFR, purchase of statins and anti-resorptive agents were collected. Exposure groups were matched using propensity score. Kaplan-Meier curves were generated to assess the time from treatment initiation to outcomes. Multivariable Cox\u2019s proportional hazards survival models estimated hazard ratios (HR) and 95% CIs for each outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 27503 patients with concurrent osteoporosis and type 2 diabetes, 627 (4.7%) received zoledronic acid and 502 (3.7%) denosumab. Prior to matching, the denosumab-treated patients were older (mean age 75.7 <jats:italic>vs<\/jats:italic> 71.9, p&amp;lt;0.01), had longer diabetes duration (mean 8.4 <jats:italic>vs<\/jats:italic> 7.2 years, p&amp;lt;0.01), and had a lower baseline eGFR (59.4 <jats:italic>vs<\/jats:italic> 75.3, p&amp;lt;0.01) than the zoledronic acid-treated patients. After matching, 415 pairs of subjects were included. The incidence of all examined outcomes was similar in the Zol and Dmab treatment groups, including 5-year cumulative incidence of fractures (38% <jats:italic>vs<\/jats:italic> 31%), death events (36% <jats:italic>vs<\/jats:italic> 41%), overall fracture risk (HR=1.17, 95% CI: 0.78 to 1.75), death risk (HR= 1.12, 95% CI:0.87 to 1.44), and mortality after a hip fracture (HR= 0.92, 95% CI:0.37-2.29).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest comparability of Zoledronic Acid and Denosumab in managing osteoporotic fractures and mortality among patients with type 2 diabetes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1590472","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T04:10:17Z","timestamp":1754280617000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Zoledronic acid and denosumab are associated with similar fracture 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