Safety of denosumab versus zoledronic acid in the older adults with osteoporosis: a meta-analysis of cohort studies.

Abstract

Denosumab is a newly approved treatment for osteoporosis in China. However, the clinical safety and advantages of denosumab have not been much established. The current study evaluates the real-world safety of denosumab versus zoledronic acid in treating cancer-free adults aged 50 years or older with osteoporosis to provide clinical settings guidelines.

PURPOSE:

A head-to-head comparison of the safety profiles between denosumab (60 mg subcutaneously every 6 months) and zoledronic acid (5 mg, intravenously yearly) was performed in cancer-free adults aged 50 years or older with osteoporosis.

METHODS:

MEDLINE, EMBASE, and Cochrane Library databases were searched for cohort studies comparing the safety of denosumab and zoledronic acid in cancer-free adults aged 50 years or older with osteoporosis till December 2021. The outcomes included the risk of fracture and other severe adverse events. Based on the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2, we identified the eligible studies.

RESULTS:

Three cohort studies having 38,845 cancer-free adults aged 50 years or older were included in the study. The results showed that denosumab was not superior to zoledronic acid in reducing fracture risk [RR (95% CI): 1.05 (0.90, 1.23), P = 0.52]. However, denosumab had a low risk of composite cardiovascular disease [RR (95% CI): 0.82 (0.70, 0.96), P = 0.01]. There were no significant differences between the hazards of serious infection, and total adverse events (P > 0.05).

CONCLUSION:

The present meta-analysis demonstrated that for cancer-free adults aged 50 years or older with osteoporosis, denosumab was as safe as zoledronic acid for the risk of drug-induced fractures. However, denosumab had a lower incidence of composite cardiovascular disease, and may be a better option for the population with cardiovascular disease. Nonetheless, due to limitations like a short-term follow-up, gender, and incomplete types of adverse effects, more randomized controlled trials (RCTs) are required to further verify this conclusion.

• Authors: Weiwei Li, Zeqiong Ning, Zhifu Yang, Tingting Fan, Minna Yao, Wei Zhang, Mingming Wang, Aidong Wen, Jingwen Wang
• Journal: Archives of osteoporosis (Arch Osteoporos) Vol. 17 Issue 1 Pg. 84 (06 17 2022) ISSN: 1862-3514 [Electronic] England
• PMID: 35715524 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © 2022. International Osteoporosis Foundation and National Osteoporosis Foundation.

Chemical References

• Bone Density Conservation Agents
• Diphosphonates
• Denosumab
• Zoledronic Acid

Topics

• Aged
• Bone Density Conservation Agents (adverse effects)
• Cardiovascular Diseases
• Cohort Studies
• Denosumab (adverse effects)
• Diphosphonates (adverse effects)
• Fractures, Bone (drug therapy)
• Humans
• Osteoporosis (chemically induced, drug therapy)
• Systematic Reviews as Topic
• Zoledronic Acid (adverse effects)