From the Guidelines
Bisphosphonates and denosumab are both effective in treating bone diseases, but denosumab is preferred in patients with renal disease due to its lower rates of renal toxicity, as shown in a large, placebo-controlled, randomized trial comparing denosumab with zoledronic acid 1.
Comparison of Bisphosphonates and Denosumab
- Bisphosphonates, such as zoledronic acid, have been shown to reduce mortality and improve progression-free survival (PFS) in patients with multiple myeloma (MM) 1.
- Denosumab, a monoclonal antibody, has been found to have similar efficacy to zoledronic acid in reducing skeletal-related events and improving overall survival (OS) in patients with MM 1.
- However, denosumab has lower rates of renal toxicity compared to zoledronic acid, making it a preferred option for patients with renal disease 1.
- Both bisphosphonates and denosumab carry risks of osteonecrosis of the jaw (ONJ) and hypocalcemia, but the rates of these adverse effects differ between the two treatments 1.
Recommendations
- The NCCN Guidelines for MM recommend bisphosphonates (category 1) or denosumab for all patients receiving therapy for symptomatic MM regardless of documented bone disease 1.
- Denosumab is preferred in patients with renal disease due to its lower rates of renal toxicity 1.
- The frequency of dosing (monthly vs every 3 months) and duration of therapy (up to 2 years or beyond) should be individualized based on patient characteristics, comorbidities, and response to therapy 1.
Key Considerations
- Patients on bisphosphonates should have their renal function monitored and undergo a dental examination before starting therapy to minimize the risk of ONJ 1.
- Denosumab requires strict adherence to dosing schedules to maintain its efficacy and minimize the risk of rebound fractures 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Bisphosphonates and Denosumab
- Bisphosphonates are a class of drugs commonly used to treat osteoporosis, with studies showing their effectiveness in reducing fracture risk 2, 3, 4.
- Denosumab, a monoclonal antibody, is also used to treat bone diseases, but there is limited direct comparison with bisphosphonates in the provided studies.
- Bisphosphonates have been shown to increase bone mass and reduce the risk of vertebral and nonvertebral fractures, including hip fractures 2, 3, 4.
- The choice of bisphosphonate and duration of treatment depend on various factors, including patient characteristics, fracture risk, and potential side effects 5, 6.
- Common bisphosphonates used include alendronate, risedronate, and zoledronate, with varying pharmacological properties and dosing intervals 3, 4.
- While bisphosphonates are generally well-tolerated, potential side effects include gastrointestinal issues, kidney function effects, and rare cases of osteonecrosis of the jaw or atypical fractures 6.
Treatment Considerations
- Treatment with bisphosphonates should be individualized, considering factors such as fracture risk, bone density, and medical history 5, 4.
- The duration of treatment with bisphosphonates is typically 3-5 years, followed by a treatment holiday, with the duration of the holiday depending on the specific drug used 5.
- There is limited evidence on the comparative efficacy of different bisphosphonates, but zoledronate may offer greater increases in bone mineral density and convenience due to less frequent administration 4.
Safety and Efficacy
- Bisphosphonates have a well-established safety profile, with rare but potential side effects, and their efficacy in reducing fracture risk has been demonstrated in numerous clinical trials 2, 3, 4, 6.
- The use of bisphosphonates is supported by various studies, with recommendations for their use in postmenopausal women and older men with osteoporosis 2, 3, 4.