A comparative analysis of Denosumab and Zoledronic acid effects on bone metabolism and bone mineral density in individuals with osteoporotic vertebral compression fractures

Background: This study aimed to compare the efficacy of Denosumab (DEN) versus Zoledronic acid (ZOL) in treating patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP). Methods: In this study, 128 OVCF patients who underwent PKP in our hospital from June 2019 to August 2022 were selected and randomized into a DEN group treated with DEN and a ZOL group treated with ZOL. Bone mineral density (BMD), bone metabolism, pain, and lumbar mobility were compared between the two groups before and after treatment, and the anterior vertebral height and local kyphotic angle were measured. Finally, the one-year refracture rate and treatment cost were counted. Results: The two groups showed no notable difference in pain, lumbar mobility, anterior vertebral height, and local kyphotic angle after treatment (P>0.050). BMD was higher in the DEN group at 6 and 12 months after treatment, while b isomer of C-terminal telopeptide of type I collagen (b-CTX) was lower (P<0.050). No statistical inter-group difference was identified in the one-year re-fracture rate (P>0.050), while the total treatment cost was lower in the DEN group compared with ZOL group (P<0.050). Conclusions: DEN and ZOL effectively improve the prognosis of OVCF patients after PKP, but DEN can more significantly improve BMD and bone metabolism with higher economic benefits.