SynthesisClinical drug investigation2026
Comparison of the Efficacy of Denosumab and Alendronate in Improving Bone Mineral Density in Osteoporosis Patients and High-Risk Populations: A Systematic Review and Meta-Analysis.
Synthesis in Clinical drug investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
Funding
Abstract
backgroundOsteoporosis, a common condition of low bone mineral density (BMD), significantly increases fracture risk. Denosumab and alendronate are both established anti-resorptive therapies, yet their comparative effectiveness remains inconsistent across studies.
objectiveThe aim of this meta-analysis was to systematically evaluate the efficacy of denosumab versus alendronate for improving BMD at multiple skeletal sites in osteoporosis patients, aiming to provide evidence for clinical decision making.
methodsMultiple databases were searched for relevant randomised controlled trials published in English (as of November 2024). The primary outcomes were mean change of BMD at different skeletal sites. Data were pooled using fixed- or random-effects models to determine the mean differences (MDs) and 95% confidence intervals (CIs) for various BMD in patients treated with denosumab in comparison to patients treated with alendronate.
resultsThis meta-analysis included thirteen randomized controlled trials (RCTs) with a total of 3364 patients and follow-up periods ranging from 6 to 24 months, and the overall quality of the studies was relatively high. The results demonstrated that denosumab was more effective than alendronate in increasing BMD at the lumbar spine (LS), femoral neck (FN), distal radius (DR), and total hip (TH) in osteoporosis patients and high-risk populations. Subgroup analysis revealed that postmenopausal women experienced greater improvements in BMD at the LS (p < 0.001) at 6 months, and at the FN (p < 0.001) at 24 months, compared with non-postmenopausal subjects.
conclusionsDenosumab was more effective than alendronate in increasing BMD. However, all the included randomised controlled trials (RCTs) carried a risk of bias, and the patient sample sizes were relatively small. Therefore, further studies with larger sample sizes and better methodological rigor are needed to confirm these findings. PROSPERO REGISTRATION NUMBER: CRD420250655676.
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