Review on the comparison of effectiveness between denosumab and bisphosphonates in post-menopausal osteoporosis

Abstract

ObjectivesOsteoporosis is a rapidly rising cause of concern for elderly patients. Various classes of drugs are available in the market. Bisphosphonates are considered as a first-line therapy for the prevention and treatment. Denosumab is an antiresorptive agent which is a RANK ligand inhibitor. There is a scarcity of comparison between these two classes of drugs. The aim of this study is to compare efficacy of Bisphosphonates and Denosumab in various parameters.MethodsLiterature search was done for randomized controlled trials (RCTs) comparing bisphosphonates with denosumab. RCTs with a treatment period of at least one year with a baseline bone mineral density (BMD) and bone turnover markers (BTM) and follow up values at one year were included in the study. All included studies were also analysed for complications. The study has also been registered in PROSPERO International prospective register of systematic reviews.ResultsA total of five RCTs were identified providing data on 3751 participants. In all five studies, the BMD changes at both hip and spine were statistically significant in favour of denosumab. Result was similar in three studies that studied BMD changes at the wrist. Denosumab also produced significant reduction in BTM as early as one month, but at one year there was no difference compared to the bisphosphonates. There was no statistically significant differences in the complication rates.ConclusionsThough both bisphosphonates and denosumab were effective with similar side effects, the latter was statistically superior in increasing the BMD and reducing the BTM.

The Bisphosphonates versus Denosumab Efficiency in Postmenopausal Osteoporosis Treatment

“…The data we obtained are consistent with the data obtained by other meta-analyses [28,29]. We can therefore affirm that Denosumab is more efficient than bisphosphonates in increasing the bone mineral density values after 12 months of treatment.…”

Comparison of Risk of Osteoporotic Fracture in Denosumab vs Alendronate Treatment Within 3 Years of Initiation

“…In randomized clinical trials (RCTs), denosumab was more efficacious than bisphosphonates in increasing bone mass among postmenopausal women. 15 , 16 Although there is an association of change in BMD with reduction in fracture risk, 17 , 18 the magnitude of the association is not well established. The RCTs examined the risk of any fracture as a secondary outcome, finding no difference in the fracture risk between denosumab and alendronate within 1 year of treatment initiation.…”

“…The RCTs examined the risk of any fracture as a secondary outcome, finding no difference in the fracture risk between denosumab and alendronate within 1 year of treatment initiation. 15 , 16 However, these studies were based on a low number of fractures, and the extent of fracture reduction with denosumab compared with alendronate in routine clinical practice is unclear from the data. Using routinely collected data from population-based health registries in Denmark, we conducted a nationwide cohort study to compare risk of hip and any fracture in patients treated with denosumab and alendronate.…”

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

“…However, these two trials did not directly compare denosumab and alendronate in fracture risk reduction. A recent review conducted by Benjamin et al (31) compared the efficacy of denosumab with that of bisphosphonates in postmenopausal osteoporosis. However, the inclusion criteria was not robust and some potentially significant articles were excluded.…”