1. Denosumab versus zoledronic acid in patients previously treated with zoledronic acid
A. D. Anastasilakis & S. A. Polyzos & A. Gkiomisi & Z. G. Saridakis. Osteoporos Int (2015) 26:2521–2527
In head-to-head comparison studies in both treatment naïve and pre-treated with oral bisphosphonates women with postmenopausal osteoporosis, denosumab has been proven superior to all oral bisphosphonates, namely alendronate, risedronate, and ibandronate in terms of BMD increases and bone turnover reduction. A recent meta-analysis has concluded that denosumab increases BMD at the lumbar spine (LS) and total hip more than bisphosphonates, including zoledronic acid, the most potent representative of the class . No study has directly compared denosumab and zoledronic acid to date in terms of BMD and bone turnover marker changes. We have recently reported that, in treatment naïve patients, denosumab increases serum levels of sclerostin, while zoledronic acid decreases them, implying a diverse effect onWnt signaling. No prior study has reported on the effect of denosumab on serum sclerostin levels in patients previously treated with zoledronic acid. Since zoledronic acid is more potent than other
bisphosphonates, sequential treatment with denosumab might not have the skeletal effects the above studies showed in patients previously treated with oral bisphosphonates, mainly alendronate. The primary aim of this study was to compare the effect of denosumab and zoledronic acid on LS BMD in postmenopausal women with low bone mass previously treated with zoledronic acid for 1 year. Secondary aims were to compare their effect on bone turnover markers (procollagen type 1 N-terminal propeptide [P1NP] and C-terminal telopeptide of type 1 collagen [CTx]), and serum sclerostin and free soluble RANKL (sRANKL) levels.