Denosumab Compared With Ibandronate in Postmenopausal Women Previously Treated With Bisphosphonate Therapy

Recknor, Chris; Czerwiński, E. J.; Bone, Henry G.; Bonnick, Sydney Lou; Binkley, Neil; Palacios, Santiago; Moffett, Alfred H.; Siddhanti, Suresh; Ferreira, Irene; Ghelani, Prayashi; Wagman, Rachel B.; Hall, Jesse; Bolognese, Michael A.; Benhamou, Claude-Laurent

doi:10.1097/aog.0b013e318291718c

Cited by 124 publications

(111 citation statements)

References 34 publications

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“…(38) It is not clear that switching treatment will offer additional reduction in risk of nonvertebral fracture. (4,(39)(40)(41)(42)(43)(44) Based on studies from patients who are not receiving treatment, the increase in risk of fracture associated with an incident nonvertebral fracture may be greatest in the first 5 years after the fracture occurs and then wane with time. (24)(25)(26)(27)(28)(29)(30)(31) Furthermore, in patients receiving zoledronic acid, incident nonvertebral fracture is an important risk factor for future nonvertebral fractures over the next 3 years if therapy is discontinued.…”

Section: Monitoring Response To Therapymentioning

confidence: 99%

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Cummings

Cosman

Lewiecki

et al. 2016

Journal of Bone and Mineral Research

137

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The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goaldirected treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care.

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Section: Monitoring Response To Therapymentioning

confidence: 99%

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Cummings

Cosman

Lewiecki

et al. 2016

Journal of Bone and Mineral Research

137

View full text Add to dashboard Cite

show abstract

“…(11)(12)(13)(14)(15)(16)(17) Effects of most osteoporosis medications differ, however, in patients who have already been pretreated with other potent osteoporosis medications. (18)(19)(20)(21)(22)(23) This is certainly true of TPTD and PTH. (24)(25)(26)(27)(28)(29)(30) BMD responses to initial TPTD/PTH followed by potent antiresorptive therapy are substantial in both spine and hip sites as a result of the effects of both components of the treatment sequence.…”

Section: Introductionmentioning

confidence: 97%

Treatment Sequence Matters: Anabolic and Antiresorptive Therapy for Osteoporosis

Cosman

Nieves

Dempster

2016

Journal of Bone and Mineral Research

201

129

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The effects of anabolic medications (teriparatide [TPTD] and parathyroid hormone [PTH]) differ in patients who have received recent treatment with potent antiresorptives. This perspective reviews studies evaluating bone density (BMD) and histomorphometric effects of treatment sequences beginning with TPTD/PTH followed by potent antiresorptives and those beginning with potent antiresorptives followed by switching to or adding TPTD. Effect of treatment sequence on spine BMD outcome is minor, with modest quantitative differences. However, when individuals established on potent bisphosphonates are switched to TPTD, hip BMD declines below baseline for at least the first 12 months after the switch to TPTD. This transient hip BMD loss is more prominent when the antiresorptive is denosumab; in this setting, hip BMD remains below baseline for almost a full 24 months. In a controlled comparison of those who switched from alendronate to TPTD versus those who added TPTD to ongoing alendronate, the effect on hip BMD was improved with combination therapy. Furthermore, hip strength improved with the addition of TPTD to ongoing alendronate, whereas it was neutral after switching from alendronate to TPTD, primarily due to the effect on cortical bone. Bone biopsy studies indicate that TPTD stimulates bone formation in patients who have not been treated previously as well as in patients on prior and ongoing bisphosphonates. Histomorphometric evidence suggests that use of alendronate with TPTD blocks the TPTD-induced increase in cortical porosity. When possible, we suggest anabolic therapy first, followed by potent antiresorptive therapy. The common practice of switching to TPTD only after patients have an inadequate response to antiresorptives (intercurrent fracture or inadequate BMD effect) is not the optimal utilization of anabolic treatment. In fact, this may result in transient loss of hip BMD and strength. In this setting, continuing a potent antiresorptive while starting TPTD might improve hip outcomes.

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“…Seven RCTs [18][19][20][21][22][23][24] were included in the present analysis that presented the necessary inclusion criteria. A total of 4535 participants were included in these 7 RCTs.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 4535 participants were included in these 7 RCTs. Five studies compared the efficacy of Denosumab vs Alendronate treatment [18,19,21,22,23], one study compared Denosumab with Risedronate [20] and one study compared Denosumab with Ibandronate [24]. All studies were verified to identify the eventual discrepancies and prejudices in randomization using the Consort checklist.…”

Section: Resultsmentioning

confidence: 99%

“…[13]. Although there are many studies in the literature which assess bisphosphonates efficacy, as well as different other drugs used in the treatment of postmenopausal osteoporosis, including Denosumab [14,15,16], the number of randomized controlled studies (RCT) is low [18][19][20][21][22][23][24]. The main purpose of this systematic analysis is to identify the studies that have compared the bisphosphonate and Denosumab efficacy and to establish which of these two treatments is better at increasing the bone mineral density of postmenopausal osteoporosis after 12 months.…”

Section: Introductionmentioning

confidence: 99%

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The Bisphosphonates versus Denosumab Efficiency in Postmenopausal Osteoporosis Treatment

Milaciu¹,

Alb²,

Moldovan³

et al. 2017

BALNEO

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Introduction. Osteoporosis is a frequently ignored disease, that has the potential to develop an adverse outcome, leading to complications that lower patients' quality of life. Postmenopausal osteoporosis is a well-studied subject, being a disease with an increasing prevalence. However, there is a large number of drugs to choose from for the treatment of postmenopausal osteoporosis. Bisphosphonates are the most used therapeutic choice but, with an almost 10-year clinical experience, RANKL inhibitor Denosumab is becoming more frequently used in practice, with great results. The main purpose of this review is to evaluate the efficacy of bisphosphonates compared with that of Denosumab by analyzing different parameters. Matherials and methods. We included randomized studies that directly compared bisphosphonates to Denosumab after 1 year of treatment, which included data regarding the bone mineral density (BMD) and bone turnover markers (BTM) measured at baseline and after 12 months. Results. Seven randomized studies were included in this review, combining a total of 4535 patients. In all 7 studies the changes in lumbar spine bone mineral density were statistically significant in favor of Denosumab. Denosumab also produced a decrease in bone turnover markers as early as 1 month from the beginning of the treatment. After 12 months of treatment the reduction percentage of BTM were similar between the two groups. The rate of adverse effects' occurrence is similar between the two groups. Conclusion. Denosumab treated patients present an increase in bone mineral density after 12 months of treatment when compared to bisphosphonates. Both therapies have a similar reduction of bone turnover markers. The rate of adverse effects' occurrence during the 12 months of monitoring were also similar between the two drugs.

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Denosumab Compared With Ibandronate in Postmenopausal Women Previously Treated With Bisphosphonate Therapy

Abstract: In postmenopausal women previously treated with a bisphosphonate and low BMD, denosumab treatment resulted in greater BMD increases than ibandronate at all measured sites. No new safety risks with denosumab treatment were identified.

Cited by 124 publications

References 34 publications

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Treatment Sequence Matters: Anabolic and Antiresorptive Therapy for Osteoporosis

The Bisphosphonates versus Denosumab Efficiency in Postmenopausal Osteoporosis Treatment

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