Potent bisphosphonate therapy for preventing fractures after denosumab discontinuation in osteoporosis: A GRADE-assessed systematic review and meta-analysis.
Asim Shah, Suleman Khan, Syeda Vilay Zehra Rizvi et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the efficacy of potent bisphosphonates (BPs) in preventing vertebral fractures after discontinuation of denosumab in adults with osteoporosis. The analysis included six studies with 683 participants, revealing that potent BP therapy significantly reduced the risk of incident vertebral fractures (RR=0.29; 95% CI: 0.14-0.59), particularly compared to no subsequent therapy.
Key findings
- Potent BP therapy reduced incident vertebral fractures by 71% (RR=0.29; 95% CI: 0.14-0.59).
- There was a 92% reduction in multiple vertebral fractures (RR=0.08; 95% CI: 0.01-0.43).
- Clinical vertebral fractures were reduced by 82% (RR=0.18; 95% CI: 0.07-0.49).
- No significant reduction in non-vertebral fractures was observed (RR=0.43; 95% CI: 0.07-2.64).
Why it matters
The findings highlight the potential of potent bisphosphonates to mitigate the risk of vertebral fractures following denosumab cessation, addressing a critical gap in osteoporosis management. This information is vital for clinicians considering sequential therapy options.
What to keep in mind
Overall certainty of evidence was low to very low due to the observational nature of most studies and imprecision in outcomes.