Denosumab: The Optimal Choice for Improving Total Hip BMD and Treating Osteoporosis

This study investigated the efficacy of different interventions for osteoporosis over varying time periods, revealing a spectrum of effectiveness and highlighting denosumab as the most promising treatment option. While bisphosphonates like alendronate, clodronate, and zoledronate initially showed positive preventive effects, their efficacy may decrease over time due to potential increased tolerance or a return to equilibrium in bone remodeling. Clodronate, with its higher absorption rate, might be more effective for longer-term treatment, as its efficacy at 12 months surpassed that at 6 months. Zoledronate, a long-acting bisphosphonate, exhibits stable effects for an extended period, likely due to its inhibition of the key enzyme FPPS involved in bone resorption. However, denosumab, a monoclonal antibody targeting RANKL, emerges as the preferred option. It consistently increases bone density for up to 10 years, exhibiting a low incidence of adverse events. Switching from long-term oral bisphosphonate therapy to denosumab has also shown greater gains in postmenopausal osteoporosis patients. Moreover, denosumab has been shown to be superior in reducing the risk of death and ischemic stroke in women with osteoporosis compared to raloxifene.

Teriparatide, while demonstrating effectiveness in improving lumbar BMD, is less recommended due to its higher cost. Raloxifene, a SERM, produces estrogen-like effects on bones but is considered less versatile than denosumab.

Previous meta-analyses have consistently demonstrated the effectiveness of denosumab and zoledronate in significantly reducing periprosthetic BMD loss after total hip arthroplasty (THA), particularly in the proximal femur, and improving hip joint function. Another study ranked anti-osteoporotic drugs for total hip BMD in postmenopausal women as denosumab > zoledronate > teriparatide, further solidifying denosumab's position as the optimal choice for improving total hip BMD. The current study further confirms denosumab's superior efficacy at 6 months, filling a gap in existing data and strengthening its recommendation.

In conclusion, while various interventions offer varying levels of efficacy for osteoporosis, denosumab stands out due to its long-term effectiveness, low incidence of adverse events, and proven ability to improve total hip BMD and reduce periprosthetic BMD loss after THA. It is considered the optimal choice for treating osteoporosis and improving hip joint function in postmenopausal women.