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11.05.2024 | Review

Denosumab vs. bisphosphonates in primary osteoporosis: a meta-analysis of comparative safety in randomized controlled trials

verfasst von: Takaomi Kobayashi, Tadatsugu Morimoto, Koji Ito, Masaaki Mawatari, Takafumi Shimazaki

Erschienen in: Osteoporosis International

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Abstract

Denosumab and bisphosphonates for primary osteoporosis are generally well-tolerated, but their comparative safety remains unclear. We aimed to explore the comparative safety of denosumab and bisphosphonates in primary osteoporosis. Databases such as PubMed and Google Scholar were searched for relevant peer-reviewed randomized controlled trials published in English (as of December 2023). Trials comparing adverse events (AE) between denosumab and bisphosphonates in patients with primary osteoporosis were investigated. Data were pooled using a fixed- or random-effects model to determine the risk ratios (RR) and 95% confidence intervals (CIs) for various AEs in patients treated with denosumab in comparison to patients treated with bisphosphonates. Eleven trials (5,545 patients; follow-up period: 12–24 months) were included in this meta-analysis. All trials had a risk of bias (e.g., reporting bias linked to secondary endpoints and selection bias linked to random allocation). In comparison to bisphosphonates, denosumab was significantly associated with less withdrawal due to AEs (RR = 0.49; 95% CI 0.34–0.71), more five-point major adverse cardiovascular events (RR = 2.05; 95% CI 1.03–4.09), more cardiovascular AEs (RR = 1.61; 95% CI 1.07–2.41), more infections (RR = 1.14; 95% CI 1.02–1.27), more upper respiratory tract infections (RR = 1.56; 95% CI 1.08–2.25), less vertebral fractures (RR = 0.54; 95% CI 0.31–0.93), and less abdominal pain (RR = 0.44;95% CI 0.22–0.87). We explored the comparative safety of denosumab and bisphosphonates for primary osteoporosis, some of which could be attributed to their beneficial effects. However, all trials had a risk of bias. Further investigations are required to confirm our results.

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Black DM, Geiger EJ, Eastell R et al (2020) Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med 383:743–753. https://doi.org/10.1056/NEJMoa1916525CrossRefPubMedPubMedCentral

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Anastasilakis AD, Polyzos SA, Makras P (2018) Therapy of endocrine disease: denosumab vs bisphosphonates for the treatment of postmenopausal osteoporosis. Eur J Endocrinol 179:R31-45. https://doi.org/10.1530/EJE-18-0056CrossRefPubMed

Titel: Denosumab vs. bisphosphonates in primary osteoporosis: a meta-analysis of comparative safety in randomized controlled trials
verfasst von: Takaomi Kobayashi
Tadatsugu Morimoto
Koji Ito
Masaaki Mawatari
Takafumi Shimazaki
Publikationsdatum: 11.05.2024
Verlag: Springer London
Erschienen in: Osteoporosis International
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-024-07118-0

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