Evidence map›Paper›PMID 37798320›Full record

Trial reportOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2024

The comparison of alendronate and raloxifene after denosumab (CARD) study: A comparative efficacy trial.

Sabashini K Ramchand, Joy N Tsai, Hang Lee, Grace Sassana-Khadka, Mackenzie Jordan, Savannah Ryan, Benjamin Z Leder

Erratum issued Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT07406685 (The Comparison of Ibandronate and Zoledronic Acid After Denosumab Discontinuation), which is not on this map. Cited by 16 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
4.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07406685 phase4recruitingnot on this mapstarted 2026, after this paper: background citation

The Comparison of Ibandronate and Zoledronic Acid After Denosumab Discontinuation: A Randomized Non-inferiority Trial

TypeinterventionalSponsorNational Taiwan University HospitalRan2026 to 2030Enrolled52ConditionsPostmenopausal Osteoporosis, Postmenopausal Osteopenia, Primary Osteoporosis, OsteoporosisArmsIbandronate IV, Zoledronic acid IV
3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. One versus 2 years of alendronate following denosumab: the CARD extension.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024
    Trial
  4. Denosumab-efficacy, safety, persistence and sequential strategies-a systematic review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Review
  5. Review
  6. Non-metastatic breast cancer patients discontinuing aromatase inhibitor on denosumab: what next?Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Review
  7. Follow-on osteoporosis therapy after denosumab discontinuation among Medicare beneficiaries.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Article
  8. Review
  9. Article
  10. Article
  11. Article
  12. Article
  13. Review
  14. Denosumab discontinuation in the clinic: implications of rebound bone turnover and emerging strategies to prevent bone loss and fractures.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025
    Review
  15. Review
  16. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Sabashini K RamchandDepartment of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA. sramchand@mgh.harvard.edu.ORCID http://orcid.org/0000-0002-6755-8469
Joy N TsaiDepartment of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Hang LeeBiostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
Grace Sassana-KhadkaDepartment of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Mackenzie JordanDepartment of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Savannah RyanDepartment of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Benjamin Z LederDepartment of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Harvard University · USMassachusetts General Hospital · US

Funding

The Harvard Clinical and Translational Science CenterUL1TR002541 · NCATS · HARVARD MEDICAL SCHOOL · PI NADLER, LEE MARSHALL · 2018 to 2022
$93.0M
Novel combination therapies in the treatment of osteoporosisK24AR067847 · NIAMS · MASSACHUSETTS GENERAL HOSPITAL · PI LEDER, BENJAMIN Z · 2015 to 2019
$926k
NCATS NIH HHS 1UL1TR002541-01NIAMS NIH HHS K24AR067847
6 · The paper itself

Abstract

Denosumab discontinuation results in accelerated bone remodeling, decreased bone mineral density (BMD), and an increased risk of multiple vertebral fractures. Bisphosphonates are at least partially effective at inhibiting these consequences but there have been no randomized clinical trials assessing the efficacy of alternative antiresorptives. PURPOSE: The aim of this study was to evaluate the comparative efficacy of alendronate and the SERM, raloxifene, in preventing the post-denosumab high-turnover bone loss.

methodsWe conducted an open-label randomized controlled trial in which 51 postmenopausal women at increased risk of fracture were randomized with equal probability to receive 12-months of denosumab 60-mg 6-monthly followed by 12-months of either alendronate 70-mg weekly or raloxifene 60-mg daily. Serum bone remodeling markers were measured at 0,6,12,15,18, and 24 and areal BMD of the distal radius, spine, and hip were measured at 0,12,18 and 24 months.

resultsAfter denosumab discontinuation, serum markers of bone remodeling remained suppressed when followed by alendronate, but gradually increased to baseline when followed by raloxifene. In the denosumab-to-alendronate group, denosumab-induced BMD gains were maintained at all sites whereas in the denosumab-to-raloxifene group, BMD decreased at the spine by 2.0% (95% CI -3.2 to -0.8, P = 0.003) and at the total hip by 1.2% (-2.1 to -0.4%, P = 0.008), but remained stable at the femoral neck and distal radius and above the original baseline at all sites. The decreases in spine and total hip BMD in the denosumab-to-raloxifene group (but not the femoral neck or distal radius) were significant when compared to the denosumab-to-alendronate group.

conclusionsThese results suggest that after one year of denosumab, one year of alendronate is better able to maintain the inhibition of bone remodeling and BMD gains than raloxifene.

Indexed as

Bone Density Conservation AgentsOsteoporosis, PostmenopausalAlendronateBiomarkersBone DensityDenosumabFemaleHumansRaloxifene HydrochlorideAlendronateBiomarkersBone Density Conservation AgentsDenosumabRaloxifene HydrochlorideDenosumabDenosumab cessationOsteoporosisRaloxifene

Identifiers

PMID37798320
OpenAlexW4387381194

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.