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A patient’s sex may be relevant when it comes to prescribing medication following a hip fracture, according to the results of a study.
Publishing the findings of the study in Osteoporosis International on 7 December 2025, researchers analysed data from 26,852 patients aged 50 years and older who had been admitted to hospital with their first recorded hip fracture, across four regions: the UK, Hong Kong, Taiwan and Australia.
The study used data from 18,292 patients who had been prescribed bisphosphonate and 8,560 who were given denosumab from 2011–2018, with a five-year “washout period”.
The researchers found that between the two drugs, there was no difference in rates of second recorded hip fracture or death. However, when subsequent hip fractures were included, bisphosphonate users had a 25% higher rate of subsequent fracture compared with denosumab users.
Males demonstrated an association between bisphosphonate use and risk of subsequent fracture, but females did not, the researchers revealed. When only cohorts made up of people with frailty, or dementia, were analysed, no link between drug type and risk of subsequent fracture was seen.
The study data also showed a link between drug type and mortality. Males taking bisphosphonate had a 10% lower rate of all-cause mortality compared with males taking denosumab, while the association was not seen in females, or when only people with frailty or dementia were analysed.
However, the authors noted that the association between bisphosphonate and a lower risk of all-cause mortality could be confounded by the presence of comorbidities. A higher proportion of males with chronic kidney disease may have been prescribed denosumab instead of bisphosphonate, owing to contraindications with the latter, they said.
The authors concluded: “Sex may be an important consideration when selecting first-line anti-resorptive medication post hip fracture.”
Jenni Ilomaki, lead author of the study and associate professor at the Centre for Medicine Use and Safety, Melbourne, Australia, said: “We set out to investigate the risk of fracture and death in people with dementia and frailty prescribed bisphosphonates or denosumab. We found no significant difference in treatment outcomes in people with or without dementia or frailty.
“We did, however, identify an unexpected sex-related difference — our hope is that this study is a building block toward better informed practice moving forward.”
Prescribing guidance from the British Geriatrics Society (BGS), published in November 2025, said that for patients with moderate frailty and osteoporosis who are taking bisphosphonate for more than three years, there is little evidence that taking it for a further three years would be beneficial.
The guidance — which covered a range of medications and conditions — is intended to help prescribers and patients balance the risk and benefits of medicines.
