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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Patients with chronic kidney disease (CKD) are at markedly increased risk of fragility fractures, which impair activities of daily living and contribute to excess morbidity and mortality. Although anti-osteoporosis therapy is essential in this high-risk population, evidence for its fracture-preventive efficacy in CKD remains limited and is largely derived from small studies. We aimed to compare the real-world effectiveness and safety of bisphosphonates and denosumab for fracture prevention in patients with CKD.
We conducted a retrospective cohort study using nationwide health screening and medical claims data from April 2014 to May 2023. We included patients aged 60 to 95 years with CKD, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, who newly initiated either a bisphosphonate or denosumab. Individuals receiving dialysis or any anti-osteoporosis medication in the prior year were excluded. New users of denosumab and bisphosphonates were matched 1:2 by propensity scores estimated from age, sex, renal function, proteinuria, comorbidities (hypertension, diabetes, and prior fracture), and use of vitamin D or calcium preparations. The primary outcome was incidence of major osteoporotic fracture. Hazard ratios (HRs) and 95% Confidence Intervals (CIs) for 2- and 5-year fracture risk were estimated using the Cox proportional hazards model. Secondary outcomes included 5-year incidence of cardiovascular disease (CVD) events, hypocalcemia, and treatment discontinuation.
After matching, 2,994 denosumab users and 4,798 bisphosphonate users were analyzed. Fracture risk was significantly lower with denosumab at both 2 and 5 years (2-year HR 0.77, 95% CI 0.64–0.93; 5-year HR 0.84, 95% CI 0.72–0.97). The 5-year cumulative incidence of fracture is shown in the figure. No significant difference was observed in CVD risk over 5 years (HR 1.02, 95% CI 0.87–1.20). Denosumab users had a higher 5-year risk of hypocalcemia (HR 6.69, 95% CI 5.00–8.96), but a lower discontinuation rate (HR 0.69, 95% CI 0.62–0.77).
In older adults with CKD, denosumab was associated with greater short- and long-term reduction in fracture risk compared with bisphosphonates. Although the risk of hypocalcemia remains elevated and necessitates careful monitoring, adherence to denosumab therapy appeared favorable. These findings suggest that with appropriate monitoring and supplementation, the superior fracture-preventive benefit of denosumab can be achieved without compromising treatment persistence.
