Efficacy of Different Interventions for Osteoporosis: A Comparative Study

The study found that different interventions have varying efficacy over different time periods. Three bisphosphonates (alendronate, clodronate, and zoledronate) showed promising preventive effects. However, the efficacy of alendronate decreased over time, potentially due to increased tolerance or a balance in bone remodeling. Bisphosphonates inhibit bone resorption, but over time, bone remodeling may return to equilibrium, leading to diminishing therapeutic effects.

In comparison to alendronate sodium, clodronate has a higher absorption rate. The research suggests that clodronate may be more effective for long-term treatment, as its efficacy at 12 months surpasses that at 6 months. Zoledronate, a long-acting bisphosphonate, exhibits stable effects for most of the time. This may be because zoledronate inhibits the key enzyme farnesyl pyrophosphate synthase (FPPS) involved in bone resorption, providing continuous protection for bone tissue.

The study suggests denosumab as a more favorable option. Denosumab is a monoclonal antibody that targets the receptor activator of nuclear factor-kB ligand (RANKL), a key regulator of bone resorption. Long-term use of denosumab has been shown to increase bone density for up to 10 years, with a low incidence of adverse events. Additionally, switching from long-term oral bisphosphonate therapy to denosumab has been associated with greater gains in postmenopausal osteoporosis patients.

Teriparatide and raloxifene have also demonstrated interesting effects. Teriparatide stimulates bone formation and inhibits bone loss by acting on the PTH receptor 1. It may be superior to alendronate in improving lumbar bone mineral density (BMD) in postmenopausal osteoporosis patients. However, due to its higher cost, teriparatide is less recommended compared to denosumab. Raloxifene, a selective estrogen receptor modulator (SERM), can produce estrogen-like effects on bones, reducing absorption and increasing BMD in postmenopausal women. While raloxifene is commonly used, denosumab has broader applicability and is superior in reducing the risk of death and ischemic stroke in women with osteoporosis.

Previous meta-analyses have shown that both denosumab and zoledronate significantly reduce periprosthetic BMD loss after total hip arthroplasty (THA), particularly in the proximal femur, and improve hip joint function. Another study ranked anti-osteoporotic drugs for total hip BMD in postmenopausal women as denosumab > zoledronate > teriparatide. Denosumab is considered the optimal choice for improving total hip BMD. The research conducted in this study fills the gap in data on denosumab at 6 months and confirms its superior efficacy, which is a strength of the study.