Abstract / Summary
Osteoporosis is a widespread bone disorder, as the bone strength is decreased, bone microarchitecture deteriorates, and an increased risk of fragility fracture occurs, especially in the elderly and postmenopausal women. Anti-resorptive drugs, such as bisphosphonates and denosumab, are commonly employed to prevent bone loss and fractures, but there is some uncertainty over how well these drugs work and whether they are safe. This systematic review and meta-analysis compares the effectiveness of denosumab to bisphosphonates for the treatment of osteoporosis. Changes in bone mineral density at the lumbar spine, total hip, and femoral neck areas and in fracture incidence, biochemical markers of bone turnover, adverse events and treatment discontinuation were evaluated in comparative clinical studies. Studies that met eligibility criteria were assessed through systematic review and meta-analysis. Based on available evidence, denosumab has demonstrated a generally higher potency to increase bone mineral density and suppress bone turnover, than bisphosphonate therapy. Results for vertebral fractures, hip fractures, and other types of osteoporotic fractures, however, are less consistent, and neither treatment shows overall better safety. Both treatments can still be used successfully in osteoporosis treatment. Therefore, treatment options should be tailored to baseline fracture risk, rather than history of treatment, renal function, tolerability, adherence, patient preference and long-term treatment planning, including the choice for discontinuation or switching between antiresorptive therapies. Keywords: Osteoporosis; Denosumab; Bisphosphonates; Bone mineral density; Fragility fracture; Antiresorptive therapy; Fracture prevention; Meta-analysis.