Comparison of Efficacy and Safety of Romosozumab versus Denosumab for Treatment of Postmenopausal Osteoporosis: A Meta-analysis

A BSTRACT Two common molecular-targeted drugs used for treating postmenopausal osteoporosis are denosumab (DEN) and romosozumab (ROMO), with the latter being a newly approved drug. The aim of this systematic review and meta-analysis was to compare the efficacy of DEN and ROMO therapy over 12 months for the management of osteoporosis in postmenopausal patients. The percentage increase in bone mineral density (BMD) at the lumbar spine was the primary outcome of interest, while secondary outcomes included bone density changes at the total hip and incidence of clinical or osteoporotic fractures. Two independent reviewers conducted an electronic search on PubMed, Google Scholar, Web of Science, and Cochrane Library until June 2023 to search for randomized controlled trials that studied the clinical efficacy of ROMO or DEN and included those that fulfilled the eligibility criteria. We used Review Manager 5.4 to analyze our data, with an odds ratio for fractures and pooled mean change for BMD. To assess heterogeneity, we used I 2 and Chi-square 2 . P < 0.05 was considered for statistical significance. This review analyzed twelve trials with a total of 22,445 participants. ROMO and DEN were associated with a significant percentage change in BMD. Patients who received ROMO had significantly lower rates of clinical and osteoporotic fractures, but this was not true for those on DEN. Both ROMO and DEN are effective treatments for osteoporosis in postmenopausal women, increasing BMD within a year. A decrease in fracture incidence is more prominent for ROMO therapy.