title: Denosumab, a new pharmacotherapy option for postmenopausal osteoporosis.
abstract: BACKGROUND
  According to the 2010 Osteoporosis Canada Clinical Practice Guidelines, denosumab is a first-line option for the pharmacological management of postmenopausal osteoporosis (PMO), along with several therapeutics that may be more familiar to family practice doctors: bisphosphonates, raloxifene, teriparatide, and hormone therapy. Denosumab is indicated for postmenopausal patients at high risk for fracture or others who have failed, or are intolerant to, other osteoporosis therapies.
  
  
  METHODS
  We undertook a review of the efficacy and safety of denosumab in PMO, searching the English-language literature on this drug via PubMed queries as of July 2012.
  
  
  RESULTS
  Although established treatments reduce fracture risk among osteoporotic postmenopausal women in trials, their effectiveness in clinical practice is limited by patient adherence. Twice-yearly denosumab treatment is associated with markedly improved bone mineral density (BMD) and cortical and trabecular bone strength, and significantly reduced osteoporotic fracture. Inhibition of bone resorption is fully reversible following discontinuation. Placebo-controlled and open-label extension studies showed similar adverse event (AE) and serious AE rates, relative to placebo, over up to 5 years. Data indicate a potential advantage of denosumab over the bisphosphonate alendronate for BMD and patient adherence and preference.
  
  
  CONCLUSIONS
  Owing to its efficacy, safety, and potential to improve adherence rates, denosumab is an appropriate first-line pharmacologic option for PMO management.
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, ON, Canada. josserg@smh.ca
authors.forename: Robert
authors.initials: R
authors.lastname: Josse
authors.forename: Aliya
authors.initials: A
authors.lastname: Khan
authors.forename: Daniel
authors.initials: D
authors.lastname: Ngui
authors.forename: Marla
authors.initials: M
authors.lastname: Shapiro
mesh_terms: D000368:Aged; D019386:Alendronate / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001862:Bone Resorption / Q000188:drug therapy; D001842:Bone and Bones / Q000187:drug effects; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D055118:Medication Adherence; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000188:drug therapy / Q000517:prevention & control; D053245:RANK Ligand / Q000187:drug effects / Q000378:metabolism; D053246:Receptor Activator of Nuclear Factor-kappa B / Q000378:metabolism
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D053245:RANK Ligand; D053246:Receptor Activator of Nuclear Factor-kappa B; C505688:TNFSF11 protein, human; D000069448:Denosumab; D019386:Alendronate