BMD gains in postmenopausal osteoporosis more favourable with denosumab vs ibandronate

Denosumab proves better than ibandronate as a sequential therapy in women with postmenopausal osteoporosis who have received romosozumab, as the former yields greater improvements in bone mineral density (BMD) with few severe adverse events (AEs), according to the results of the VICTOR study.

VICTOR included 124 patients who completed 12 months of romosozumab for severe postmenopausal osteoporosis. They were randomized to receive either ibandronate (n=62) or denosumab (n=62) for another 12 months.

For the primary endpoint, researchers assessed the percentage changes in BMD at the lumbar spine, total hip, and femoral neck from 12 months (at romosozumab completion) to 18 and 24 months of total treatment (6 and 12 months, respectively, after the conversion to sequential therapy). Secondary endpoints included alterations in serum bone turnover markers and the incidence of AEs.

From 12 to 24 months, BMD at the lumbar spine increased by 2.5 percent in the ibandronate group and 5.4 percent in the denosumab group. The changes observed were substantial relative to baseline in both groups (p<0.01). Moreover, the difference between the two groups was significant (p<0.01), establishing the superiority of denosumab in increasing BMD at the lumbar spine.

BMD gains at the total hip and femoral neck likewise showed comparably favourable trends.

Additionally, there were marked reductions in P1NP and TRACP-5b from 12 to 24 months (−64.9 percent and −26.8 percent with ibandronate; and −67.4 percent and −36.3 percent with denosumab, respectively; p<0.001 for all).

Several minor adverse events were documented in both groups, but none of these led to the discontinuation of treatment.