Denosumab vs. Other Interventions for Osteoporosis: A Comparative Analysis

In addition to denosumab, other interventions such as alendronate, zoledronate, clodronate, teriparatide, and raloxifene have shown positive effects in treating osteoporosis. Alendronate, clodronate, and zoledronate are bisphosphonates that reduce bone loss by inhibiting bone resorption. However, the effectiveness of alendronate decreases over time, potentially due to the gradual increase in tolerance or the balance of bone remodeling. Clodronate, on the other hand, is more effective at 12 months compared to 6 months, possibly because it has a higher rate of absorption. Zoledronate, being a long-acting bisphosphonate, consistently exhibits stable effects for most of the time, attributed to its unique mechanism of inhibiting bone resorption. Despite the effectiveness of these interventions, our study indicates that both denosumab and other RANKL receptor inhibitors, represented by it, demonstrate better effects, whether comparing individual drugs or classifying drugs based on mechanisms. Previous studies have shown that in postmenopausal osteoporosis patients who had been on long-term oral bisphosphonate therapy, switching to denosumab was associated with greater gains than zoledronate, further supporting our viewpoint. Furthermore, teriparatide and raloxifene have shown promising effects. Teriparatide acts on the PTH receptor 1, inducing a significant increase in bone formation markers while simultaneously inhibiting bone loss caused by sustained elevation of parathyroid hormone levels. A meta-analysis suggests that teriparatide may be superior to alendronate in improving lumbar BMD in postmenopausal osteoporosis patients. However, due to its higher cost, teriparatide is less recommended compared to drugs such as denosumab. Raloxifene, a second-generation selective estrogen receptor modulator (SERM), can bind to estrogen receptors and produce estrogen-like effects on the bones, reducing absorption and increasing BMD in postmenopausal women. Raloxifene is commonly used in clinical practice for women, while denosumab exhibits broader applicability. Moreover, denosumab is superior to raloxifene in reducing the risk of death and ischemic stroke in women with osteoporosis.