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- Talk
- Canada
Bisphosphonates versus Denosumab for Prevention of Pathological Fractures in Advanced Cancers with Bone Metastasis: A Meta-Analysis of Randomized Controlled Trials
Description
In this presentation at the Canadian Orthopedic Association's virtual conference, Faisal Alfayyadh highlights a study comparing the effectiveness of bisphosphonates—zelodronic acid and denosumab—in preventing pathological fractures in patients with advanced cancers that have spread to the bones. The discussion begins with an overview of the prevalence of bone metastases associated with cancers like breast, prostate, and lung cancer, and the skeletal-related events that can occur, such as spinal cord compression and persistent pain.
The study aims to conduct a meta-analysis of systematic reviews focused on the specific occurrence of pathological fractures, emphasizing stringent inclusion criteria, notably the necessity for reported outcomes related to actual fractures. Four studies were ultimately included, all with consistent dosing regimens for both denosumab and zelodronic acid.
The results indicate a 14% reduction in the occurrence of fractures with denosumab, as evidenced by an odds ratio of 86.86 and a statistically significant p-value of 0.04. Further subgroup analyses revealed no notable differences when categorizing patients by cancer type. A discussion on the differing mechanisms of action of the two medications is introduced, with denosumab being a monoclonal antibody targeting the RANK ligand and zelodronic acid functioning as a direct osteoclast inhibitor.
Alfayyadh concludes by urging the need for further studies to assess long-term outcomes and side effect profiles of both medications, particularly noting concerns regarding renal insufficiency and osteonecrosis of the jaw associated with zelodronic acid. The presentation wraps up with the speaker inviting questions during the Q&A session.