BY-Dr. Pawan Namdeorao Chavhan, Dr. Swapnil Rathod.-
Volume 1 Issue 1 (May-Aug) 2024, Article 5 (pp.39-47)
Key Points
Question:
How does the efficacy and safety of bisphosphonates compare to denosumab in the treatment of postmenopausal osteoporosis?
Findings:
In this systematic review and meta-analysis of randomized controlled trials and cohort studies, denosumab demonstrated a higher reduction in fracture risk compared to bisphosphonates, with significantly fewer vertebral fractures reported among denosumab users. However, denosumab was also associated with a higher risk of infections compared to bisphosphonates.
Meaning:
Denosumab may offer greater efficacy in reducing fracture risk for postmenopausal osteoporosis compared to bisphosphonates, but its use may be associated with an increased risk of infections, suggesting a need for careful patient selection and monitoring.
Abstract
Importance:
Postmenopausal osteoporosis is a widespread condition that significantly increases the risk of fractures, leading to substantial morbidity and healthcare costs. Understanding the relative efficacy and safety of various treatments is critical for optimizing patient outcomes.
Objective:
This systematic review aims to compare the efficacy and safety profiles of bisphosphonates versus denosumab in the treatment of postmenopausal osteoporosis. The review focuses on assessing these treatments’ impact on fracture risk reduction and identifying potential adverse effects in postmenopausal women diagnosed with osteoporosis.
Evidence Review:
A comprehensive literature search was conducted using databases such as PubMed, Embase, and the Cochrane Library from inception to March 2024. The search strategy included keywords related to “postmenopausal osteoporosis,” “bisphosphonates,” and “denosumab.” Studies were selected based on predefined inclusion criteria, including randomized controlled trials and cohort studies comparing bisphosphonates and denosumab. The quality of the included studies was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Reference lists of selected articles were also reviewed to identify additional relevant studies.
Findings:
A total of 25 studies, including 15 randomized controlled trials and 10 cohort studies, were included in the review, encompassing over 30,000 participants. The evidence indicates that denosumab is more effective than bisphosphonates in reducing the risk of vertebral and hip fractures among postmenopausal women. Specifically, denosumab users experienced a 35% greater reduction in vertebral fracture risk and a 20% greater reduction in hip fracture risk compared to bisphosphonate users. However, denosumab was associated with a higher incidence of infections, while bisphosphonates were more likely to cause gastrointestinal side effects.
Conclusions and Relevance:
This systematic review suggests that while denosumab offers superior fracture risk reduction compared to bisphosphonates in postmenopausal osteoporosis, it carries a higher risk of infections. Clinicians should weigh these benefits and risks when choosing an osteoporosis treatment strategy, considering individual patient risk profiles and preferences. Further research is needed to understand better the long-term effects and comparative safety of these therapies.
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