Denosumab in the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis

Abstract

Objective

Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis. In May 2018, denosumab was approved for the treatment of GIOP in men and women at high risk of fracture. We undertook a systematic review and meta-analysis to summarize the efficacy and safety of denosumab in the prevention and treatment of GIOP.

Methods

We searched PubMed, CINAHL, American College of Rheumatology and American Society for Bone and Mineral Research meeting abstracts for relevant studies. We included studies in which subjects were taking systemic glucocorticoid therapy and were assigned to take denosumab or control therapy, and assessed the effect of treatment on areal bone mineral density (BMD), fractures and/or safety.

Results

Three eligible studies were included in the primary meta-analysis. Denosumab significantly increased lumbar spine BMD (2.32%, 95% CI 1.73%, 2.91%, P<0.0001) and hip BMD (1.52%, 95% CI 1.1%,1.94%, P<0.0001) compared to bisphosphonates. Adverse events, serious adverse events and fractures were similar between denosumab and bisphosphonate arms.

Conclusion

Results suggest that denosumab is superior to bisphosphonates in its effects on lumbar spine and total hip BMD in patients with GIOP. There was no difference in the incidence of infections, adverse events or serious adverse events. Studies were underpowered to detect differences in the risk of fracture. Denosumab is a reasonable option for treatment of GIOP. However, further studies are needed to guide transitions off denosumab.

Keywords:

• denosumab
• glucocorticoid-induced osteoporosis
• bone mineral density
• fractures
• safety

Abbreviations

BMD, bone mineral density; FDA, Food and Drug Administration; GIOP, glucocorticoid-induced osteoporosis; RANKL, receptor-activator nuclear kappa B ligand.

Author contributions

YZ and KEH contributed equally to the design of the study. YZ performed the primary literature review, which was replicated by KEH. Both authors performed data extraction and entry. KEH performed statistical analysis. YZ and KEH contributed equally to drafting of the manuscript and approval of the final version. Both authors agree to be accountable for all aspects of the work including data accuracy.

Disclosure

The authors report no conflicts of interest in this work.