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Meta-Analysis
. 2018 Aug 2;13(1):194.
doi: 10.1186/s13018-018-0865-3.

Denosumab compared to bisphosphonates to treat postmenopausal osteoporosis: a meta-analysis

Jiaqi Wu  1 , Qingsheng Zhang  1 , Guanghui Yan  1 , Xianhui Jin  2
Affiliations
Meta-Analysis

Denosumab compared to bisphosphonates to treat postmenopausal osteoporosis: a meta-analysis

Jiaqi Wu et al. J Orthop Surg Res. .

Abstract

Background: 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.

Methods: Published 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.

Results: Eleven 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95% confidence interval (CI), 0.82-1.55; P = 0.466), adverse events (AEs) (RR 1.00; 95% CI 0.96-1.04; P = 0.957) and withdrawn due to AEs (RR 0.68; 95% CI 0.34-137; P = 0.280).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).

Conclusions: Our 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.

Keywords: Bisphosphonates; Denosumab; Fracture; Meta-analysis.

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Conflict of interest statement

This is a meta-analysis; no relative problems exist.

Not applicable.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of trials through the meta-analysis
Fig. 2
Fig. 2
The risk of bias summary, +, no bias; −, bias;?, bias unknown
Fig. 3
Fig. 3
Risk of bias of graph of the included randomized controlled trials
Fig. 4
Fig. 4
Forest plots of the included studies comparing the risk of fracture
Fig. 5
Fig. 5
Funnel plot of the risk of fracture
Fig. 6
Fig. 6
Egger test for risk of fracture
Fig. 7
Fig. 7
Begg’s test for risk of fracture
Fig. 8
Fig. 8
Sensitivity analysis for risk of fracture
Fig. 9
Fig. 9
Forest plots of the included studies comparing the AEs
Fig. 10
Fig. 10
Forest plots of the included studies comparing the withdrawn due to AEs
Fig. 11
Fig. 11
Forest plots of the included studies comparing the change in total hip BMD
Fig. 12
Fig. 12
Forest plots of the included studies comparing the change in femoral neck BMD
Fig. 13
Fig. 13
Forest plots of the included studies comparing the change in lumbar spine BMD
Fig. 14
Fig. 14
Forest plots of the included studies comparing the change in one-third radius BMD
See this image and copyright information in PMC

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