Comparison of denosumab and oral bisphosphonates for the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

Abstract

Background Both denosumab and bisphosphonates have been demonstrated effective for glucocorticoid-induced osteoporosis. However, evidence-based medicine is still lacking to prove the clinical results between denosumab and bisphosphonates. This meta-analysis aims to compare the efficacy and safety between denosumab and oral bisphosphonates for the treatment of glucocorticoid-induced osteoporosis through evidence-based medicine. Methods MEDLINE, EMBASE, and the Cochrane library databases were searched up to June 2022 for randomized controlled trials that compared denosumab and oral bisphosphonates in the treatment of glucocorticoid-induced osteoporosis. The following outcomes were extracted for comparison: percentage change in bone mineral density from baseline at the lumbar spine, total hip, femoral neck, and ultra-distal radius; percentage change from baseline in serum concentration of bone turnover markers; and incidence of treatment-emergent adverse events. Results Four randomized controlled trials involving 714 patients were included. The pooled results showed that denosumab was superior to bisphosphonates in improving bone mineral density in lumbar spine (mean difference (MD) 1.70; 95% confidence interval (CI) 1.11–2.30; P < 0.001) and ultra-distal radius (MD 0.87; 95% CI 0.29–1.45; P = 0.003), and in suppressing C-terminal telopeptide of type 1 collagen (MD -34.83; 95% CI -67.37--2.28; P = 0.04) and procollagen type 1 N-terminal propeptide (MD -14.29; 95% CI -23.65- -4.94; P = 0.003) at 12 months. No significant differences were found in percentage change in total hip or femoral neck bone mineral density at 12 months, or in the incidence of treatment-emergent adverse events or osteoporosis-related fracture. Conclusions Compared with bisphosphonates, denosumab is superior in improving bone mineral density in lumbar spine and ultra-distal radius for glucocorticoid-induced osteoporosis. Further studies are needed to prove the efficacy of denosumab.

Long-Term Bone Mineral Density Changes in Kidney Transplant Recipients Treated with Denosumab: A Retrospective Study with Nonequivalent Control Group

“…The present data corroborate the effectiveness of denosumab in increasing BMD at all sites, without significant signals for safety concerns, especially in terms of the risk of hypocalcaemia. The use of denosumab in this patient population is supported by the fact that, unlike bisphosphonates, this molecule does not interfere with kidney function [ 24 ], and it has been associated with greater BMD increases also in cases of corticosteroid-induced osteoporosis [ 25 ].…”

Fufang Zhenshu Tiaozhi capsule enhances bone formation and safeguards against glucocorticoid-induced osteoporosis through innovative Mekk2-mediated β-catenin deubiquitination

“…They have been shown to signi cantly enhance osteoblast proliferation and downregulate osteocyte apoptosis 30 . Denosumab has been shown to be bene cial for maintaining bone matrix in the lumbar vertebra and hip in patients with GIOP compared to bisphosphonates, according to a meta-analysis study 31 . However, the safety of these drugs is still a matter of debate, and undesirable side effects such as osteonecrosis of the jaw have been reported 30,32 .…”

Denosumab, teriparatide and bisphosphonates for glucocorticoid-induced osteoporosis: a Bayesian network meta-analysis

“…The best therapeutic option for GIO, however, is still controversial. Several traditional pairwise meta-analysis have been performed to compare different treatments (Yanbeiy and Hansen, 2019;Yamaguchi et al, 2020;Jiang et al, 2022). However, network meta-analysis, having the advantages of indirect comparisons and ranking, is still in lack.…”