Adherence to denosumab therapy and all-cause mortality in dialysis patients with osteoporosis: a retrospective cohort exploratory study

Background: Dialysis patients have a high risk of osteoporosis, leading to increasedfracture and mortality rates. Denosumab is commonly used in thispopulation due to its lack of renal accumulation, but its long-termbenefit depends on sustained adherence. This This exploratory study investigated therelationship between denosumab adherence and all-cause mortality indialysis patients with osteoporosis. Methods: This retrospective case--control study included 1,200 hemodialysis patients. Four hundred deceased patientswere matched 1:3 by age, sex, and follow-up duration to 1,200 survivingcontrols. Adherence to denosumab therapy was calculated, and itsassociation with mortality was assessed using Cox regression analysis. Results: Among 401 denosumab-treated patients, 12 died and 389 survived duringfollow-up. The deceased group was older than survivors (85.0 ± 11.07 vs.75.87 ± 10.24 years, *p* = 0.016). Poor adherence occurred in 50% ofdeceased patients versus 7.5% of survivors (*p*