Decreased incidence of shoulder arthroplasty in patients prescribed anti-resorptive therapy for osteoporosis.

Abstract

Rationale: Evaluate whether osteoporosis treatment influences osteoarthritis (OA) progression, using total shoulder arthroplasty (TSA) incidence as a proxy.

Main result: Osteoporosis treatment was associated with lower TSA incidence compared with untreated patients.

Significance: Findings may clarify the relationship between osteoporosis management and shoulder OA progression, informing patient counseling and management.

Purpose: We evaluated in this study the impact of osteoporosis (OP) medications in patients with shoulder osteoarthritis (OA) and compared the incidence of total shoulder arthroplasty (TSA) in treated versus untreated OP patients. We hypothesized that OP medications would lead to a decreased progression of OA, manifesting as a decreased incidence of TSA.

Methods: Using the TriNetX database, patients with OP diagnosed with primary shoulder OA were identified. Propensity score matching (1:1) was performed to control for relevant comorbidities, creating two cohorts of patients receiving antiresorptive therapy (denosumab or bisphosphonates) and untreated OP controls (n = 4,163 per group). A sub-analysis was conducted using similarly matched cohorts comparing denosumab versus bisphosphonates (n = 844 per group). The outcome of interest was the 5-year incidence of TSA in addition to TSA-free survival. Significance was set at p < 0.05.

Results: The matched cohorts in both analyses were properly balanced. Patients receiving antiresorptive therapy demonstrated a lower 5-year incidence of TSA compared with untreated controls (1.80% vs 2.60%, p = 0.014), which was confirmed on Kaplan-Meier survival analysis (Hazard ratio HR 0.69, 95% CI 0.52-0.93). In contrast, no significant differences were observed between patients receiving denosumab and those receiving bisphosphonates in terms of 5-year TSA incidence (1.8% vs 1.4%, p = 0.561) or on Kaplan-Meier analysis (HR 1.25, 95% CI 0.58-2.67).

Conclusion: OP medications in patients with shoulder OA were associated with a reduced incidence of TSA. No differences were observed between denosumab and bisphosphonates. These findings suggest a potential role for antiresorptive therapy in delaying progression of shoulder OA.