INTRODUCTION@#
Osteoporosis is the main cause of fractures among
women after
menopause. This study aimed to evaluate the
efficacy and
safety of
denosumab compared to
bisphosphonates in treating
postmenopausal osteoporosis.@*
METHODS@#Databases including
PubMed and the Cochrane Central
Register of Controlled Trials were systematically searched for randomised controlled trials (RCTs) that directly compared
denosumab and
bisphosphonates. RCTs that studied both
denosumab and
bisphosphonates in postmenopausal
women with
osteoporosis and had a Jadad score ≥ 3 were included.@*RESULTS@#Nine studies were eligible for inclusion. They were further categorised into six cohort groups. All studies had
denosumab with oral
bisphosphonates as the active comparator. Four out of six
cohort studies showed significant improvements in
bone strength (p < 0.001) at the distal
radius,
tibia, total
hip,
femoral neck, lumbar
spine and
trochanter at 12 months for
patients on
denosumab compared to the
bisphosphonate group.
Serum C-telopeptide of cross-linked
collagen, a
bone turnover marker, was consistently lower in the
denosumab group in all studies. There were no significant differences in hypocalcaemia, atypical fractures, fragility fractures,
osteonecrosis of the
jaw, all
infections (including
fever or
influenza-like symptoms), gastrointestinal side effects or dermatological conditions in all studies, except for one that did not
document side effects.@*CONCLUSION@#
Denosumab can be used both as a first-line agent and an alternative to
bisphosphonate in the
treatment of
postmenopausal osteoporosis. There is currently insufficient data to show that
denosumab is not inferior to
bisphosphonates in fracture prevention.