Osteoporosis and Risk of Hearing Loss: Protective Effects of Zoledronic Acid and Denosumab in a Nationwide Cohort.

BACKGROUND: Osteoporosis and fragility fractures may be associated with hearing loss, but whether osteoporosis treatments influence this risk remains unclear. DESIGN: Retrospective cohort study. SETTING: Taiwan's National Health Insurance Research Database (2011-2017). PARTICIPANTS: For Objective 1, adults aged 65 years and older with osteoporosis or fragility fractures (n = 331,867) and matched controls (n = 331,867); for Objective 2, patients with osteoporosis or fragility fractures treated with zoledronic acid (n = 21,811), treated with denosumab (n = 21,811), or without treatment (n = 21,811). MEASUREMENTS: The primary outcome was incident hearing loss. Propensity score matching (1:1 or 1:1:1) was performed using age, sex, and Charlson Comorbidity Index covariates. Hazard ratios (HRs) were estimated using Cox proportional hazards models adjusted for comorbidities. RESULTS: Patients with osteoporosis or fragility fractures showed a significantly higher incidence of hearing loss than controls (adjusted HR: 1.34, 95% CI: 1.31-1.37, p < 0.001). Among affected individuals, those treated with zoledronic acid (HR: 0.87, 95% CI: 0.81-0.93) or denosumab (HR: 0.91, 95% CI: 0.85-0.97) had a significantly lower risk of hearing loss than untreated patients. Zoledronic acid reduced the risk of hearing loss in both sexes, whereas the association of denosumab with reduced risk was statistically significant only in male patients. CONCLUSION: Osteoporosis and fragility fractures are associated with an increased risk of hearing loss. Treatment with zoledronic acid was associated with a reduced risk of hearing loss in both sexes, whereas denosumab was associated with such a reduction only in male patients.