Denosumab versus bisphosphonates for treatment of postmenopausal osteoporosis: a meta-analysis

Bisphosphonate is a first-line treatment for osteoporosis. Denosumab is a monoclonal antibody against human IgG-2 that has become common for the treatment of osteoporosis in postmenopausal women. Their efficacy is in controversy. We thus performed a systematic review and meta-analysis to compare the efficacy and safety of denosumab with bisphosphonates to treat osteoporosis. EMBase, PubMED, CNKI and Cochrane Clinical Controlled Experiment Center databases were searched from inception to March 2019. Randomized controlled trials (RCTs) comparing denosumab with bisphosphonates to treat osteoporosis were included. Both random-effect/fixed effect models were used for meta-analysis. Revman 5.3 was used for meta-analysis. Twelve studies depicting 11 RCTs with a total of 6392 patients were collected in the final meta-analysis. As for changes in bone mineral density (BMD) of the lumbar spine, total hip and femoral neck, the pooled outcomes all favored Denosumab (P < 0.00001). In terms of adverse events and severe adverse events, no significant difference was observed. Similar outcomes were detected in the incidences of fractures and mortality, and the pooled RRs were 1.06 (95% CI: 0.81, 1.39; I-2 = 0%, P = 0.68) and 0.64 (95% CI: 0.20, 2.06; I-2 = 0%, P = 0.45), respectively. Conclusions: This meta-analysis suggests that compared with bisphosphonates, denosumab can significantly increase BMD of hip, lumbar vertebra, femoral neck and other places in postmenopausal osteoporotic women; and the safety of the two drugs is similar, with no significant difference.