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J Clin Endocrinol Metab. 2019 May 1;104(5):1753-1765. doi: 10.1210/jc.2018-02236.

Comparison of Denosumab and Bisphosphonates in Patients With Osteoporosis: A Meta-Analysis of Randomized Controlled Trials.

Author information

1
Department of Orthopedics, Chinese PLA General Hospital, Beijing, China.
2
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
3
Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts.
4
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
5
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
6
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
7
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
8
Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
9
Harvard Medical School, Boston, Massachusetts.
10
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

CONTEXT:

It is uncertain which osteoporosis therapy is more effective: bisphosphonates or denosumab.

OBJECTIVE:

To determine whether denosumab therapy increases bone mineral density (BMD) and reduces fracture risk more so than bisphosphonates in patients with low BMD or osteoporosis.

METHODS:

The PubMed, Embase, and the Cochrane Library databases were searched through November 2018 for head-to-head, randomized, controlled trials comparing denosumab and bisphosphonates among adult patients with low BMD or osteoporosis. Random-effects models were used.

RESULTS:

We identified 10 eligible trials including 5361 participants. Denosumab increased BMD more than bisphosphonate at 12 months (mean difference, 1.42%; 95% CI, 0.95% to 1.89%; P < 0.001) at lumbar spine, 1.11% (95% CI, 0.91% to 1.30%; P < 0.001) at total hip, and 1.00% (95% CI, 0.78% to 1.22%; P < 0.001) at femoral neck. At 24 months, the respective increase differences were 1.74% (95% CI, 1.05% to 2.43%; P < 0.001), 1.22% (95% CI, 0.66% to 1.77%; P < 0.001), and 1.19% (95% CI, 0.65% to 1.72%; P < 0.001). There was no difference in fracture end point at 12 months, but denosumab had a lower osteoporotic fracture incidence than alendronate at 24 months (risk ratio, 0.51; 95% CI, 0.27 to 0.97).

CONCLUSION:

Denosumab improved BMD significantly more than bisphosphonate treatment at the lumbar spine, total hip, and femoral neck at 12 and 24 months. Only one study demonstrated greater osteoporotic fracture reduction with denosumab treatment. Longitudinal studies with longer follow-up and large sample size are needed to confirm the efficacy difference.

PMID:
30535289
PMCID:
PMC6447951
[Available on 2019-12-10]
DOI:
10.1210/jc.2018-02236
[Indexed for MEDLINE]
Free PMC Article

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