Comparison of denosumab vs. bisphosphonates in osteoporosis patients: A meta-analysis of randomized controlled trials.

Comparison of denosumab vs. bisphosphonates in osteoporosis patients: A meta-analysis of randomized controlled trials.

J Clin Endocrinol Metab. 2018 Dec 10;:

Authors: Lyu H, Jundi B, Xu C, Tedeschi SK, Yoshida K, Zhao S, Nigwekar SU, Leder BZ, Solomon DH

Abstract
Background: Among the currently available osteoporosis therapeutics, bisphosphonates and denosumab are widely used. However, it remains uncertain which therapy is more effective.
Objective: To determine whether the use of denosumab increases bone mineral density (BMD) and reduces the risk of fractures more than bisphosphonates in patients with low BMD or osteoporosis.
Data Sources: We searched PubMed, Embase and the Cochrane Library through Nov 2018.
Study Selection: Head-to-head randomized controlled trials comparing denosumab versus bisphosphonates among adult patients with low BMD or osteoporosis.
Data Extraction and Synthesis: Random-effects models were used. We identified 10 eligible trials including 5361 participants. Denosumab increased BMD more than bisphosphonate at 12 months, with a mean difference of 1.42% (95% CI 0.95-1.89%, p<0.001) at lumbar spine, 1.11% (95% CI 0.91-1.30%; p<0.001) at total hip, and 1.00% (95% CI 0.78-1.22%, p<0.001) at femoral neck. At 24 months, the increase difference was 1.74% (95% CI 1.05-2.43%, p<0.001) at lumbar spine, 1.22% (95% CI 0.66-1.77%, p<0.001) at total hip, and 1.19% (95% CI 0.65-1.72%, p<0.001) at femoral neck. There was no difference in fracture endpoint at 12 months, but denosumab had a lower osteoporotic fracture incidence than alendronate at 24 months (RR 0.51, 95% CI 0.27-0.97).
Conclusions: Denosumab improved BMD significantly more than bisphosphonates at the lumbar spine, total hip and femoral neck at 12 and 24 months. There was only one study demonstrating greater osteoporotic fracture reduction using denosumab. Future longitudinal studies with longer follow-up and large sample size are needed to confirm the efficacy difference.

PMID: 30535289 [PubMed - as supplied by publisher]

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