Efficacy of Denosumab over Alendronate in the Treatment of Osteoporotic Vertebral Fractures in Back Pain Patients

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Efficacy of Denosumab over Alendronate in the Treatment of Osteoporotic Vertebral Fractures in Back Pain Patients

Denosumab averts the osteoporotic fractures and particularly hinders the receptor activator for nuclear factor-kappa B ligand (RANKL). Earlier studies have portrayed the effects of denosumab and alendronate alone on the bone mineral density (BMD) or reduction of fracture risk. The effects of antiresorptive osteoporosis pharmacotherapy on pain relief in patients with the fresh vertebral fracture is explained in this presented study by Tetsunaga T and colleagues.

A total of 80 patients (10 males, 70 females) were included in this retrospective, single-center study.

They treated fresh osteoporotic vertebral fractures with denosumab at a dose of 60 mg subcutaneously, every 6 months (40 patients) or alendronate at a dose of 35 mg orally every week (40 patients) for 6 months. The mean age of patients was 77 years (range, 55–92 years). The duration of pain was the primary outcome. The changes in BMD, serum type 1 collagen cross-linked N-telopeptide (NTX), and serum N-terminal propeptide of type 1 collagen (P1NP) from baseline to 6 months comprised the secondary outcomes. The Pain Catastrophizing Scale (PCS) was used to estimate the pain catastrophizing because of back pain and further vertebral fracture and adverse events were also estimated.

The pain relief was acquired at a mean of 3.3 weeks with denosumab and 5.4 weeks with alendronate. A significant pain relief was observed with denosumab first and then alendronate. The change in BMD was higher with denosumab (6.1%) than with alendronate (0.8%) at 6 months. The changes in the NTX and P1NP depicted no crucial differences between groups. The results for PCS were remarkably lower for denosumab than for alendronate. The occurrence of further vertebral fractures was 5% with denosumab and 10% with alendronate and similar adverse events were reported between the groups.

It was thus concluded that denosumab permitted earlier pain relief than alendronate. After 6 months of treatment, it hindered catastrophizing in patients with osteoporotic vertebral fractures.


Journal of orthopaedic science

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The original title of the article:

Denosumab and alendronate treatment in patients with back pain due to fresh osteoporotic vertebral fractures


Tomoko Tetsunaga et. al

Therapeutic, Denosumab, Alendronate, Osteoporotic Vertebral Fractures, Vertebrae Bones, Monoclonal Antibody, Bisphosphonate, Retrospective, Single-center Study, PCS, Subcutaneous, Oral
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