Abstract
BackgroundThe standard treatment for osteoporosis was controversial. Denosumab and bisphosphonates were two most common drugs. The purpose of this study was to compare the efficacy and safety of denosumab with bisphosphonates to treat osteoporosis.MethodsPublished literatures, only including randomized controlled trials (RCTs), were searched in the following electronic databases: PubMed, Embase, Web of Science, Cochrane Library, and Google database from inception to April 20 2018. Studies that compared denosumab with bisphosphonates to treat osteoporosis were included. Random-effect model was used for meta-analysis due to the unavoidable clinical heterogeneity. We used the risk of fracture as the primary outcome. Stata 12.0 was used for meta-analysis.ResultsEleven studies involving 5446 patients (denosumab = 2873, bisphosphonates = 2573) were included in the present meta-analysis. There was no significant difference between the risk of fracture (risk ratio (RR), 1.13; 95% confidence interval (CI), 0.82–1.55; P = 0.466), adverse events (AEs) (RR 1.00; 95% CI 0.96–1.04; P = 0.957) and withdrawn due to AEs (RR 0.68; 95% CI 0.34–137; P = 0.280). Denosumab compared with bisphosphonates significantly increased change in total hip, femoral neck, lumbar spine, and one-third radius bone mineral density (BMD) for postmenopausal osteoporosis patients (P < 0.05).ConclusionsOur meta-analysis suggested that denosumab but not bisphosphonates significantly increased change in total hip, femoral neck, lumbar spine, and one-third radius BMD for postmenopausal osteoporosis patients. Current evidence suggested no benefit of denosumab for reducing risk of fracture than bisphosphonates. More long-term follow-up RCTs are needed to identify the potential complications of denosumab.
Highlights
The standard treatment for osteoporosis was controversial
Our meta-analysis comprehensively and systematically reviewed the current available literature and found that (1) denosumab compared with bisphosphonates significantly increased change in total hip, femoral neck, lumbar spine, and one-third radius bone mineral density (BMD) for postmenopausal osteoporosis patients
The evidence of benefit was consistent when we further performed a sensitivity analysis; (2) denosumab has no benefit for reducing the risk of fracture when compared with bisphosphonates; (3) and the occurrence of adverse events (AEs) and withdrawn due to AEs were similar in denosumab and bisphosphonates
Summary
The standard treatment for osteoporosis was controversial. Denosumab and bisphosphonates were two most common drugs. The purpose of this study was to compare the efficacy and safety of denosumab with bisphosphonates to treat osteoporosis. Osteoporosis (OP) is a common contributor to hip and spine fractures in worldwide patients [1, 2]. OP is a global public health problem and affects appropriately 75 million people in the USA [3]. The ideal therapeutic goal is to increase the bone mass, and subsequently decrease the risk of fracture [4]. Bisphosphonates, a classic antiresorptive agent, is currently the most common therapy for osteoporosis [5]. Compliance was the major concern of bisphosphonates [6]. Prolonged medication and possible complications limited the effects of bisphosphonates for OP patients
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