Denosumab versus alendronate in long-term glucocorticoid users: A 12-month randomized controlled trial

Area of Science:

• Endocrinology
• Rheumatology
• Osteoporosis Research

Background:

• Long-term glucocorticoid (GC) use is a significant risk factor for secondary osteoporosis.
• Maintaining bone mineral density (BMD) is crucial for preventing fractures in patients on chronic GC therapy.

Purpose of the Study:

• To compare the effectiveness of denosumab versus alendronate in improving lumbar spine BMD.
• To evaluate the impact of these treatments on bone turnover markers and overall BMD in long-term GC users.

Main Methods:

• A randomized trial involving adult patients on long-term prednisolone (≥2.5 mg/day for ≥1 year).
• Participants received either subcutaneous denosumab (60 mg/6 months) or oral alendronate (70 mg/week).
• BMD and bone markers were assessed at baseline, 6, and 12 months, with spine BMD as the primary outcome.

Main Results:

• Denosumab treatment resulted in a significantly greater increase in lumbar spine BMD compared to alendronate at 12 months.
• Both agents increased hip and femoral neck BMD, but the difference between groups was not significant for these sites.
• Denosumab induced a more pronounced reduction in bone turnover markers (P1NP and CTX) than alendronate.

Conclusions:

• Denosumab is more effective than alendronate in enhancing spine BMD in patients on long-term glucocorticoids.
• Both denosumab and alendronate are safe and well-tolerated in this patient population, with comparable rates of adverse events.