Denosumab therapy is associated with a reduced risk of clinically diagnosed rotator cuff tears: a multi-institutional real-world cohort study.

Authors

Hung-Kuan Yen, I-Hsin Chen, Han-Ying Wang, I-Ching Chiang, Li-Wei Hung, Shau-Huai Fu, Hongsen Chiang, Tzu-Hao Tseng

Published in

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

This large multi-institutional cohort study evaluated whether denosumab therapy is associated with rotator cuff tear risk. Denosumab use was associated with a lower incidence of clinically diagnosed rotator cuff tears compared with discontinuation and bisphosphonate therapy, suggesting no adverse association with tendon-to-bone integrity.
To evaluate whether denosumab therapy is associated with the risk of clinically diagnosed rotator cuff tears in adults aged ≥ 50 years.
A retrospective cohort study was conducted using the TriNetX global research network. Two analytic strategies were used: a discontinuation design comparing continued denosumab users with single-dose users and an active-comparator design comparing new denosumab users with new bisphosphonate users. Patients with prior rotator cuff tear or Paget disease were excluded. Propensity score matching and landmark analysis at 225 days were applied. Cox proportional hazards models estimated hazard ratios.
After matching, 61,952 patients per group were included in the discontinuation cohort and 113,949 per group in the active-comparator cohort. In the discontinuation analysis, continued denosumab use was associated with a lower risk of nontraumatic RC tear compared with single-dose users (0.7% vs 0.9%; HR, 0.42; 95% CI, 0.37-0.48). In the active-comparator analysis, denosumab users also had a lower risk of clinically diagnosed RC tear than bisphosphonate users (0.7% vs 0.9%; HR, 0.80; 95% CI, 0.73-0.88). Similar trends were observed for clinically diagnosed overall RC tears. Surgical outcomes were reduced in the discontinuation analysis but were not significantly different in the active-comparator analysis.
Denosumab therapy was associated with a reduced incidence of clinically diagnosed rotator cuff tears compared with both discontinuation and bisphosphonate therapy. These findings suggest that denosumab does not adversely affect the tendon-to-bone interface and may have a protective association with clinically relevant rotator cuff pathology.

PMID:
42406060
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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