Efficacy and safety of denosumab compared to bisphosphonates in improving bone strength in postmenopausal osteoporosis: a systematic review

Abstract

RESULTS Nine studies were eligible for inclusion. They were further categorised into six cohort groups. All studies had denosumab with oral bisphosphonates as the active comparator. Four out of six cohort studies showed significant improvements in bone strength (p < 0.001) at the distal radius, tibia, total hip, femoral neck, lumbar spine and trochanter at 12 months for patients on denosumab compared to the bisphosphonate group. Serum C-telopeptide of cross-linked collagen, a bone turnover marker, was consistently lower in the denosumab group in all studies. There were no significant differences in hypocalcaemia, atypical fractures, fragility fractures, osteonecrosis of the jaw, all infections (including fever or influenza-like symptoms), gastrointestinal side effects or dermatological conditions in all studies, except for one that did not document side effects. CONCLUSION Denosumab can be used both as a first-line agent and an alternative to bisphosphonate in the treatment of postmenopausal osteoporosis. There is currently insufficient data to show that denosumab is not inferior to bisphosphonates in fracture prevention.

Zoledronic acid modulates osteoclast apoptosis through activation of the NF-κB signaling pathway in ovariectomized rats

“…Bisphosphonates have been widely used in clinics to treat metastatic bone cancer, Paget disease, and osteoporosis. 17,18 A conventional dose is about 100 µg/kg, but the optimal doses and durations still await further optimization 19 for different pathologies since long-term treatment with a high dose has been shown to cause bisphosphonate-related osteonecrosis of jaw, especially in the mandible. 20 Zoledronic acid (ZOL), a third-generation nitrogen-containing bisphosphonate, has been shown to be the most effective bisphosphonate in the treatment of osteoporosis.…”

An Approach for the Prevention, Diagnosis, and Treatment of Jaw Osteonecrosis: Report of a Case Associated with Zoledronic Acid

“…Bisphosphonates are widely used for the treatment of bone lesions, mostly by postmenopausal women [ 9 ]. Antiresorptive use has increased in recent years due to new molecular targets and immunological drugs used for oncologic treatment.…”

Osteoblast Dysfunction in Non-Hereditary Sclerosing Bone Diseases

“…Evidence of the anti-cancer effect was observed in breast cancer cells [ 46 ] and a meta-analysis showed disease-free survival benefits and a 15% improvement in overall survival [ 47 ]. Denosumab is a human monoclonal antibody that inhibits the activity of RANKL and osteoclasts; is injected subcutaneously in metastatic bone disease every 4 weeks and shows similar side effects to bisphosphonates such as osteonecrosis of the jaw, nausea, diarrhea and weakness [ 48 ]. Canabozantinib is a multikinase inhibitor targeting VEGFR2, MET, KIT, and mutationally activated RET.…”