Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: A randomized, blinded, phase 3 trial

Jacques P. Brown, Richard L. Prince, Chad Deal, Robert R. Recker, Douglas P. Kiel, Luiz H. De Gregorio, Peyman Hadji, Lorenz C. Hofbauer, Jose M. Álvaro-Gracia, Huei Wang, Matthew Austin, Rachel B. Wagman, Richard Newmark, Cesar Libanati, Javier San Martin, Henry G. Bone

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Abstract

Denosumab is a fully human monoclonal antibody that inhibits bone resorption by neutralizing RANKL, a key mediator of osteoclast formation, function, and survival. This phase 3, multicenter, double-blind study compared the efficacy and safety of denosumab with alendronate in postmenopausal women with low bone mass. One thousand one hundred eighty-nine postmenopausal women with a T-score ≤ -2.0 at the lumbar spine or total hip were randomized 1:1 to receive subcutaneous denosumab injections (60 mg every 6 mo [Q6M]) plus oral placebo weekly (n = 594) or oral alendronate weekly (70 mg) plus subcutaneous placebo injections Q6M (n = 595). Changes in BMD were assessed at the total hip, femoral neck, trochanter, lumbar spine, and one-third radius at 6 and 12 mo and in bone turnover markers at months 1, 3, 6, 9, and 12. Safety was evaluated by monitoring adverse events and laboratory values. At the total hip. denosumab significantly increased BMD compared with alendronate at month 12 (3.5% versus 2.6%; p <0.0001). Furthermore, significantly greater increases in BMD were observed with denosumab treatment at all measured skeletal sites (12-mo treatment difference: 0.6%, femoral neck; 1.0%, trochanter; 1.1%, lumbar spine; 0.6%, one-third radius; p ≤ 0.0002 all sites). Denosumab treatment led to significantly greater reduction of bone turnover markers compared with alendronate therapy. Adverse events and laboratory values were similar for denosumab- and alendronate-treated subjects. Denosumab showed significantly larger gains in BMD and greater reduction in bone turnover markers compared with alendronate. The overall safety profile was similar for both treatments.

Original languageEnglish (US)
Pages (from-to)153-161
Number of pages9
JournalJournal of Bone and Mineral Research
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2009

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All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Brown, J. P., Prince, R. L., Deal, C., Recker, R. R., Kiel, D. P., De Gregorio, L. H., Hadji, P., Hofbauer, L. C., Álvaro-Gracia, J. M., Wang, H., Austin, M., Wagman, R. B., Newmark, R., Libanati, C., San Martin, J., & Bone, H. G. (2009). Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: A randomized, blinded, phase 3 trial. Journal of Bone and Mineral Research, 24(1), 153-161. https://doi.org/10.1359/jbmr.0809010