Comparative effectiveness of denosumab versus zoledronic acid in type 2 diabetes patients with osteoporosis in Sunpasitthiprasong Hospital
Keywords:
Osteoporosis, Denosumab, Zoledronic acidAbstract
Denosumab and zoledronic acid are highly effective antiresorptive agents currently used for the treatment of osteoporosis. However, comparative evidence regarding their effectiveness in patients with Type 2 diabetes mellitus (T2DM) remains limited. This study aims to compare the incidence of new osteoporosis fractures, changes in bone mineral density (BMD), and adverse drug reactions between the two medications in patients with diabetes. This retrospective study included T2DM patients with osteoporosis who received either denosumab (60 mg subcutaneously every 6 months) or zoledronic acid (5 mg intravenously yearly) at Sunpasitthiprasong Hospital between 2014 to 2023. The study included 252 patients, divided into 126 individuals per group. Baseline characteristics indicated that patients in the denosumab group were significantly older and had a higher prevalence of chronic kidney disease and prior fractures compared to the zoledronic acid group. No statistically significant difference was observed in the risk of new vertebral fractures between the two groups (aHR 1.41, 95% CI: 0.58–3.44). A 12-month event-free survival analysis revealed a fracture-free survival rate of 100% in the denosumab group compared to 97.62% (95% CI: 0.9280–0.9923) for the zoledronic acid. Post-treatment, lumbar spine BMD increased by 20.38% in the denosumab group and 15.89% in the zoledronic acid group. No serious adverse events were reported for either medication. The study demonstrated no statistically significant difference between the two therapeutic agents regarding the incidence of new osteoporosis fractures. Furthermore, denosumab maintained its clinical efficacy even within high-risk subgroups, specifically among elderly patients and those with chronic kidney disease (CKD).
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