Houchen Lyu1,2,3, Bakr Jundi2, Chang Xu3, Sara K Tedeschi2,3, Kazuki Yoshida3,4,5, Sizheng Zhao3,6, Sagar U Nigwekar7, Benjamin Z Leder8,9, Daniel H Solomon3,9,10. 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.
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.
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Authors: Houchen Lyu; Sizheng S Zhao; Kazuki Yoshida; Sara K Tedeschi; Chang Xu; Sagar U Nigwekar; Benjamin Z Leder; Daniel H Solomon Journal: J Clin Endocrinol Metab Date: 2019-11-01 Impact factor: 5.958
Authors: Houchen Lyu; Bakr Jundi; Chang Xu; Sara K Tedeschi; Kazuki Yoshida; Sizheng Zhao; Sagar U Nigwekar; Benjamin Z Leder; Daniel H Solomon Journal: J Clin Endocrinol Metab Date: 2019-05-01 Impact factor: 5.958
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Authors: Houchen Lyu; Sizheng S Zhao; Kazuki Yoshida; Sara K Tedeschi; Chang Xu; Sagar U Nigwekar; Benjamin Z Leder; Daniel H Solomon Journal: J Clin Endocrinol Metab Date: 2020-05-01 Impact factor: 5.958
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