Evidence map›Paper›PMID 40646275›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

Comparison of bone mineral density changes between denosumab and bisphosphonates in tenofovir-exposed chronic hepatitis B patients with osteoporosis.

Yunmi Ko, Byeong Geun Song, Hyunjae Shin, Youngsu Park, Jeayeon Park, Min Kyung Park, Yun Bin Lee, Su Jong Yu, Dong Hyun Sinn, Yoon Jun Kim and 4 more

Erratum issuedAbstract readComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Yunmi Ko *Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Byeong Geun Song *Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hyunjae ShinDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Youngsu ParkDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Jeayeon ParkDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Min Kyung ParkDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Yun Bin LeeDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Su Jong YuDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Dong Hyun SinnDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Yoon Jun KimDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Jung-Hwan YoonDepartment of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Seung Shin Park *Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. parkseungsin@gmail.com.
Moon Haeng Hur *Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. mhhur@snu.ac.kr.
Jeong-Hoon Lee *Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. pindra@empal.com.ORCID http://orcid.org/0000-0002-0315-2080

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

This study compared denosumab and bisphosphonates for osteoporosis in tenofovir-exposed chronic hepatitis B patients. Both denosumab and bisphosphonates increased bone mineral density (BMD) at year 1. However, denosumab resulted in a greater BMD improvement and a more pronounced reduction in procollagen type 1 N-terminal peptide (P1NP) compared to bisphosphonate. These findings suggest that while both drugs have beneficial effects, denosumab may be the more effective therapeutic option in this population.

backgroundTenofovir disoproxil fumarate (TDF), a first-line antiviral for chronic hepatitis B (CHB), is a risk factor for osteoporosis. This study aimed to compare the effectiveness of denosumab and bisphosphonates for osteoporosis in TDF-exposed CHB patients.

methodsCHB patients who were treated with either denosumab or bisphosphonates for newly diagnosed osteoporosis during > 1 year of TDF treatment between 2010 and June 2024 were included from two tertiary centers in Korea. The primary outcome was bone mineral density (BMD) change at year 1 in the lumbar spine (LS) and femoral neck (FN). Secondary outcomes included changes in two bone turnover markers, procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type 1 collagen (CTX).

resultsA total of 155 patients were included: 79 received denosumab and 76 received bisphosphonates. The median time from TDF initiation to osteoporosis diagnosis was 4.8 years. After balancing baseline characteristics using propensity score matching, the denosumab group showed a significant increase in BMD at the LS and FN (denosumab vs. bisphosphonates: LS, 11.7% vs. 6.4%, P = 0.001; FN, 4.9% vs. 1.7%, P = 0.008) at year 1. The denosumab group had a greater reduction in P1NP levels at 6 months (-72.7% vs. -63.8%, P = 0.001), with no significant difference in CTX changes (-70.8% vs. -71.4%, P = 0.74) compared to the bisphosphonates group. The inverse probability of treatment weighting analyses reproduced a similar trend.

conclusionsIn TDF-exposed CHB patients with osteoporosis, denosumab outperformed bisphosphonates in the LS and FN BMD at year 1. The reduction in P1NP level was also more prominent in the denosumab group.

Indexed as

Antiviral AgentsBone Density Conservation AgentsDenosumabDiphosphonatesHepatitis B, ChronicOsteoporosisTenofovirAdultAgedBone DensityFemaleFemur NeckHumansLumbar VertebraeMaleMiddle AgedAntiviral AgentsBone Density Conservation AgentsDenosumabDiphosphonatesPeptide FragmentsProcollagenprocollagen Type I N-terminal peptideTenofovirAntiresorptive agentsChronic hepatitis BOsteoporosisTenofovir disoproxil fumarate

Identifiers

PMID40646275

What OpenQuestion holds

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Registered trials

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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.