title: Denosumab for the treatment of osteoporosis: a systematic literature review.
abstract: OBJECTIVE
  To determine the efficacy and safety of denosumab in osteoporosis.
  
  
  METHODS
  A systematic search was performed in MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials (1950 to July 2010), meeting abstracts (2009-2010), trial registries, and reference lists. The selection criteria were as follows: (population) osteoporosis patients of any age; (intervention) treatment with denosumab; (outcome) efficacy and safety; (study design) randomized clinical trials (RCTs); no language restrictions. Two reviewers independently screened titles and abstracts and subsequently extracted data from the selected studies including quality items, and on outcomes of interest. A meta-analysis was performed for safety issues.
  
  
  RESULTS
  A total of 25 studies were included. Denosumab reduces the risk of new radiographic vertebral fracture in a 68% compared with placebo (p<0.001) and increases bone mineral density (BMD) at lumbar spine, total hip, and one-third radius more than alendronate and placebo. A single subcutaneous dose of denosumab resulted in a dose-dependent, rapid, profound, and sustained decrease bone turnover markers (BTMs). Denosumab was in general well tolerated. A meta-analysis has shown an increase in the incidence of urinary infections (p=0.012) and eczema (p<0.001) in the patients treated with denosumab. Meta-analysis of efficacy was complicated due to the study features.
  
  
  CONCLUSIONS
  Denosumab given subcutaneously twice yearly is associated with a reduction in the risk of vertebral, nonvertebral, and hip fractures in women with osteoporosis. Denosumab is associated with greater and sustained increases in BMD and reductions in BTMs compared with placebo and/or alendronate and with a risk of urinary infections and eczema.
authors.affiliation: Rheumatology Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain. luciasilva@ser.es
authors.forename: Lucía
authors.initials: L
authors.lastname: Silva-Fernández
authors.forename: María Piedad
authors.initials: MP
authors.lastname: Rosario
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Martínez-López
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Loza
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D000069448:Denosumab; D006801:Humans; D007279:Injections, Subcutaneous; D015233:Models, Statistical; D010024:Osteoporosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D000069448:Denosumab